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Neitzel E, Stearns J, Guido J, Porter K, Whetten J, Lammers L, vanSonnenberg E. Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures. Abdom Radiol (NY) 2024:10.1007/s00261-024-04381-x. [PMID: 38849536 DOI: 10.1007/s00261-024-04381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. METHODS A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. RESULTS 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. CONCLUSION Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA.
| | - Jack Stearns
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jessica Guido
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Kaiden Porter
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jed Whetten
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Luke Lammers
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
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Houk JL, Kranz PG, Amrhein TJ. Percutaneous Treatment and Post-treatment Management of CSF Leaks and CSF-Venous Fistulas in Spontaneous Intracranial Hypotension. Radiol Clin North Am 2024; 62:333-343. [PMID: 38272625 DOI: 10.1016/j.rcl.2023.09.003] [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] [Indexed: 01/27/2024]
Abstract
Spontaneous intracranial hypotension (SIH) is a treatable cause of orthostatic headaches secondary to pathologic loss of cerebrospinal fluid (CSF) from the subarachnoid space. SIH has several known pathologic causes including dural tears from disc osteophytes, leaks emanating from nerve root sleeve diverticula, and CSF-venous fistulas (CVFs). Depending on the type of leak, surgical repair or endovascular techniques may be options for definite treatment. However, epidural blood patching (EBP) remains first-line therapy for many patients due to its long track record, broad availability, and relatively lower risk profile. This review focuses on indications and techniques for the percutaneous treatment of SIH and provides an overview of post-procedural management of these patients.
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Affiliation(s)
- Jessica L Houk
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Box 3808, Durham, NC 27710, USA.
| | - Peter G Kranz
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Box 3808, Durham, NC 27710, USA
| | - Timothy J Amrhein
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Box 3808, Durham, NC 27710, USA
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3
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Gallant GG, Matzon JL, Beredjiklian PK, Rivlin M. Perioperative Management of Oral Anticoagulants and Antiplatelet Therapy in Hand and Wrist Surgery. J Am Acad Orthop Surg 2023; 31:820-833. [PMID: 37478048 DOI: 10.5435/jaaos-d-22-00751] [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: 08/11/2022] [Accepted: 05/05/2023] [Indexed: 07/23/2023] Open
Abstract
There is wide variability in the management of patients on antithrombotic therapy requiring surgery of the hand and wrist. There are no specific guidelines regarding whether to temporarily cease or continue oral anticoagulants and antiplatelet agents. Discontinuation of these medications before surgery can lead to perioperative thromboembolic or ischemic events. On the other hand, continuation can lead to intraoperative or postoperative bleeding complications. This review discusses various anticoagulants and antiplatelet agents with special considerations for their management, analyzes the current literature, summarizes current recommendations, and provides direction for additional research.
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Affiliation(s)
- Gregory G Gallant
- From the Hand Surgeon Rothman Orthopaedics, Thomas Jefferson University Rothman Orthopaedics, Sidney Kimmel Medical College, Philadelphia, PA
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Kumar H, Boini A, Tshibangu M, Ghosh B, Shaheen F, Joseph AM, Cazzaniga J, Karas M, Jara Silva CE, Quinonez J, Ruxmohan S. Anticoagulation Options for Cranial Procedures: A Comparative Review of Aspirin, Plavix, and Aggrastat. Cureus 2023; 15:e43899. [PMID: 37746498 PMCID: PMC10512101 DOI: 10.7759/cureus.43899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Anticoagulation therapy is critical to avoiding thrombotic events in patients following cranial surgery. Although Aspirin, Plavix, and Aggrastat are used as anticoagulants for this purpose, there is no consensus on which agent is the most effective and safe. In this comparative study, we analyze the current evidence on the efficacy and safety of these three anticoagulants in the context of cranial surgeries. This review focuses on the advantages and disadvantages of each anticoagulant, such as its pharmacokinetics, indications, contraindications, and possible consequences. The outcomes of this study will help physicians choose the best anticoagulant for their patients based on individual patient characteristics and the kind of cranial procedure. Aggrastat's potential to be included as a recommended anticoagulant for cranial procedures warrants further study.
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Affiliation(s)
- Harendra Kumar
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Aishwarya Boini
- Medicine, Government Medical College and Hospital, Siddipet, IND
- Medicine, Davao Medical School Foundation, Davao, PHL
| | | | - Bikona Ghosh
- Medicine and Surgery, Dhaka Medical College, Dhaka, BGD
| | - Fatima Shaheen
- Medicine, M. N. Raju (MNR) Medical College, Hyderabad, IND
| | - Andrew M Joseph
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Juliana Cazzaniga
- Herbert Wertheim College of Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Monica Karas
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Cesar E Jara Silva
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Jonathan Quinonez
- Neurology/Osteopathic Neuromuscular Medicine, Larkin Community Hospital, Miami, USA
| | - Samir Ruxmohan
- Division of Neurocritical Care, University of Texas (UT) Southwestern Medical Center, Dallas, USA
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5
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Minici R, Fontana F, Venturini M, Guzzardi G, Piacentino F, Spinetta M, Bertucci B, Serra R, Costa D, Ielapi N, Coppola A, Guerriero P, Apollonio B, Santoro R, Mgjr Research Team, Brunese L, Laganà D. A Multicenter Retrospective Cohort Study Evaluating the Clinical Outcomes of Patients with Coagulopathy Undergoing Transcatheter Arterial Embolization (TAE) for Acute Non-Neurovascular Bleeding. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1333. [PMID: 37512144 PMCID: PMC10383976 DOI: 10.3390/medicina59071333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Transcatheter arterial embolization (TAE) is the mainstay of treatment for acute major hemorrhage, even in patients with coagulopathy and spontaneous bleeding. Coagulopathy is associated with worsening bleeding severity and higher mortality and clinical failure rates. Furthermore, some unanswered questions remain, such as the definition of coagulopathy, the indication for TAE or conservative treatment, and the choice of embolic agent. This study aims to assess the efficacy and safety of TAE for spontaneous non-neurovascular acute bleeding in patients with coagulopathy. Materials and Methods: This study is a multicenter analysis of retrospectively collected data of consecutive patients with coagulopathy who had undergone, from January 2018 to May 2023, transcatheter arterial embolization for the management of spontaneous hemorrhages. Results: During the study interval (January 2018-May 2023), 120 patients with coagulopathy underwent TAE for spontaneous non-neurovascular acute bleeding. The abdominal wall was the most common bleeding site (72.5%). The most commonly used embolic agent was polyvinyl alcohol (PVA) particles or microspheres (25.0%), whereas coils and gelatin sponge together accounted for 32.5% of the embolic agents used. Technical success was achieved in all cases, with a 92.5% clinical success rate related to 9 cases of rebleeding. Complications were recorded in 12 (10%) patients. Clinical success was significantly better in the group of patients who underwent correction of the coagulopathy within 24 h of TAE. Conclusions: Transcatheter arterial embolization (TAE) is effective and safe for the management of acute non-neurovascular bleeding in patients with coagulopathy. Correction of coagulopathy should not delay TAE and vice versa, as better clinical outcomes were noted in the subgroup of patients undergoing correction of coagulopathy within 24 h of TAE.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Bernardo Bertucci
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Davide Costa
- Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Pasquale Guerriero
- Radiology Unit, Santobono-Pausilipon Hospital, 80129 Naples, Italy
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | | | - Rita Santoro
- Haemophilia and Thrombosis Center, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | | | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
- Scientific Committee of the Italian National Institute of Health (Istituto Superiore di Sanità, ISS), 00161 Rome, Italy
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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Sugawara S, Sone M, Sakamoto N, Sofue K, Hashimoto K, Arai Y, Tokue H, Takigawa M, Mimura H, Yamanishi T, Yamagami T. Guidelines for Central Venous Port Placement and Management (Abridged Translation of the Japanese Version). INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:105-117. [PMID: 37485481 PMCID: PMC10359169 DOI: 10.22575/interventionalradiology.2022-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/22/2022] [Indexed: 07/25/2023]
Abstract
The central venous port has been widely used for patients who require long-term intravenous treatments, and the number of palcement has been increasing. The Japanese Society of Interventional Radiology developed a guideline for central venous port placement and management to provide evidence-based recommendations to support healthcare providers in the decision-making process regarding the central venous port. The guideline consisted of two parts: (i) a comprehensive review of topics including preoperative preparation, techniques for placement or removal, complications, and maintenance methods and (ii) recommendations for the six clinical questions regarding blood vessels for central venous port placement, port implantation site, prophylactic antibiotic therapy, imaging guidance for puncture, disinfectant prior to accessing the central venous port, and the optimal procedure at the end of drug administration via the central venous port, generated on the basis of the rating quality of evidence by systematic review.
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Affiliation(s)
- Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | | | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Japan
| | | | - Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi University, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi University, Japan
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7
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Taylor J, Stiepel HR, Keefe N. Anticoagulation and Antiplatelet Agents in Peripheral Arterial Interventions. Semin Intervent Radiol 2022; 39:364-372. [PMID: 36406033 PMCID: PMC9671689 DOI: 10.1055/s-0042-1757314] [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: 11/19/2022]
Abstract
Effective revascularization of peripheral artery disease relies on periprocedural pharmacological regulation of the clotting cascade. Patient-specific factors such as cardiovascular risk factors, contraindications, and individual psychosocial factors must be considered when initiating post revascularization management. Management with anticoagulant and antiplatelet agents is discussed to guide the interventionalist on which therapy may be appropriate for their patient. While exact treatment may be institution and provider dependent, the interventionist must be familiar with the available classes of medications and how they can be prescribed in the postprocedural setting to improve cardiovascular outcomes.
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Affiliation(s)
- Jordan Taylor
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Henry R. Stiepel
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Nicole Keefe
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Arfi Rouche J, Jalaguier Coudray A, Roullet S, Poncelet É, Thomassin-Naggara I, de Bazelaire C, Moalla S, Balleyguier C. Micro- et macrobiopsies mammaires chez les patientes sous traitement antithrombotique. IMAGERIE DE LA FEMME 2021. [DOI: 10.1016/j.femme.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Aljundi L, Chaar A, Boshara P, Shiari A, Gennaoui G, Noori Z, Girard C, Szpunar S, Franco-Elizondo R. Incidence of bleeding in patients on different anticoagulants and antiplatelet therapies undergoing thoracentesis. BMJ Open Respir Res 2021; 8:8/1/e000874. [PMID: 34281915 PMCID: PMC8291320 DOI: 10.1136/bmjresp-2021-000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/13/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Thoracentesis is one of the most commonly performed procedures in the inpatient setting. Although coagulation profile is usually evaluated prior to thoracentesis, bleeding is a rare complication, occurring in less than 1% of the cases. Several society guidelines recommend holding antiplatelet medications and anticoagulants prior to thoracentesis. Clinical practice guidelines also recommend correcting international normalised ratios of more than two and platelet counts <50 X10∧9/L. Methods This is a retrospective descriptive study that included 292 patients who underwent thoracentesis in the inpatient setting at Ascension St John Hospital in Detroit, Michigan, USA from 2016 to 2018. We identified patients who had uncorrected risk for bleeding and collected data about their demographics, comorbidities, use of antiplatelet or anticoagulants and procedural details including complications. We looked for any postprocedural bleeding events to study their relation to the already established bleeding risk. Results Two hundred and ninety-two thoracenteses were performed, 95.5% (n=279) were performed by interventional radiology. Majority of patients were at risk of bleeding 83% (n=242). No bleeding events occurred. Medications that were not held prior to thoracentesis included: clopidogrel 11% (n=32), novel anticoagulants 8.2% (n=24) and unfractionated heparin 50% (n=146). Use of ultrasound guidance decreased the amount of haemoglobin decline from 1 to 2 g/L (p=0.029). Seventeen patients suffered pneumothorax, eight of which required intervention. Discussion Our study suggests that performing thoracentesis without correction of underlying coagulopathy may be safe. This may prevent consequences of holding essential medications and reduce the amount of blood products administered to patients in need of thoracentesis.
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Affiliation(s)
- Lamia Aljundi
- Internal Medicine, Ascension St John Hospital, Detroit, Michigan, USA
| | - Abdelkader Chaar
- Internal Medicine, Ascension St John Hospital, Detroit, Michigan, USA
| | - Peter Boshara
- Internal Medicine, Ascension St John Hospital, Detroit, Michigan, USA
| | - Aryan Shiari
- Internal Medicine, Ascension St John Hospital, Detroit, Michigan, USA
| | - George Gennaoui
- Internal Medicine, Ascension St John Hospital, Detroit, Michigan, USA
| | - Zaid Noori
- Internal Medicine, Ascension St John Hospital, Detroit, Michigan, USA
| | - Cristine Girard
- St George's University, School of Medicine, West Indies, Grenada
| | - Suzan Szpunar
- Medical Education, Ascension St John Hospital, Detroit, Michigan, USA
| | - Rene Franco-Elizondo
- Pulmonary, Critical Care and Sleep Medicine, Ascension St John Hospital, Detroit, Michigan, USA
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Páez-Carpio A, Gómez FM, Isus Olivé G, Paredes P, Baetens T, Carrero E, Sánchez M, Vollmer I. Image-guided percutaneous ablation for the treatment of lung malignancies: current state of the art. Insights Imaging 2021; 12:57. [PMID: 33914187 PMCID: PMC8085189 DOI: 10.1186/s13244-021-00997-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/09/2021] [Indexed: 12/25/2022] Open
Abstract
Image-guided percutaneous lung ablation has proven to be a valid treatment alternative in patients with early-stage non-small cell lung carcinoma or oligometastatic lung disease. Available ablative modalities include radiofrequency ablation, microwave ablation, and cryoablation. Currently, there are no sufficiently representative studies to determine significant differences between the results of these techniques. However, a common feature among them is their excellent tolerance with very few complications. For optimal treatment, radiologists must carefully select the patients to be treated, perform a refined ablative technique, and have a detailed knowledge of the radiological features following lung ablation. Although no randomized studies comparing image-guided percutaneous lung ablation with surgery or stereotactic radiation therapy are available, the current literature demonstrates equivalent survival rates. This review will discuss image-guided percutaneous lung ablation features, including available modalities, approved indications, possible complications, published results, and future applications.
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Affiliation(s)
- Alfredo Páez-Carpio
- Department of Radiology, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - Fernando M Gómez
- Department of Radiology, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gemma Isus Olivé
- Department of Radiology, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pilar Paredes
- Department of Nuclear Medicine, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Tarik Baetens
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Enrique Carrero
- Department of Anesthesiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Department of Radiology, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ivan Vollmer
- Department of Radiology, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain
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11
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Periprocedural Anticoagulation and Antiplatelet Medications Management for Interventional Radiology Procedures. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00380-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Spiliopoulos S, Katsanos K, Paraskevopoulos I, Mariappan M, Festas G, Kitrou P, Papageorgiou C, Reppas L, Palialexis K, Karnabatidis D, Brountzos E. Multicenter retrospective study of transcatheter arterial embolisation for life-threatening haemorrhage in patients with uncorrected bleeding diathesis. CVIR Endovasc 2020; 3:95. [PMID: 33301058 PMCID: PMC7728894 DOI: 10.1186/s42155-020-00186-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/29/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We retrospectively investigated outcomes of emergency TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding diathesis. MATERIALS AND METHODS This multicenter, retrospective, study, was designed to investigate the safety and efficacy of percutaneous TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding disorder at the time of embolization. All consecutive patients with uncorrected coagulation who underwent TAE for the treatment of haemorrhage, between January 1st and December 31th 2019 in three European centers were included. Inclusion criteria were thrombocytopenia (platelet count < 50,000/mL) and/or International Normalized Ratio (INR) ≥2.0, and/or activated partial thromboplastin time (aPTT) > 45 s, and/or a pre-existing underlying blood-clotting disorder such as factor VIII, Von Willebrand disease, hepatic cirrhosis with abnormal liver function tests. Primary outcome measures were technical success, rebleeding rate and clinical success. Secondary outcome measures included patients' 30-day survival rate, and procedure-related complications. RESULTS In total, 134 patients underwent TAE for bleeding control. A subgroup of 17 patients with 18 procedures [11 female, mean age 70.5 ± 15 years] which represent 12.7% of the total number of patients, presented with pathological coagulation parameters at the time of TAE (haemophilia n = 3, thrombocytopenia n = 1, cirrhosis n = 5, anticoagulants n = 7, secondary to bleeding n = 1) and were analyzed. Technical success was 100%, as in all procedures the bleeding site was detected and successfully embolised. Clinical success was 100%, as none of the patients died of bleeding during hospitalization, nor was surgically treated for bleeding relapse. Only one rebleeding case was noted (5.9%) that was successfully treated with a second TAE. No procedure-related complications were noted. According to Kaplan-Meier analysis the estimated 30-day survival rate was 84.2%. CONCLUSION TAE in selected patients with uncorrected bleeding diathesis should be considered as a suitable individualized management approach. Emergency TAE for life threatening haemorrhage in patients with coagulation cascade disorders should be used as an aid in realistic clinical decision making.
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Affiliation(s)
- Stavros Spiliopoulos
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
- grid.417581.e0000 0000 8678 4766Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Konstantinos Katsanos
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Ioannis Paraskevopoulos
- grid.417581.e0000 0000 8678 4766Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Martin Mariappan
- grid.417581.e0000 0000 8678 4766Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Georgios Festas
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Panagiotis Kitrou
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Christos Papageorgiou
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Lazaros Reppas
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Konstantinos Palialexis
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Dimitrios Karnabatidis
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Elias Brountzos
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
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McMahon P, Reichman M, Dodelzon K. Bleeding risk after percutaneous breast needle biopsy in patients on anticoagulation therapy. Clin Imaging 2020; 70:114-117. [PMID: 33157367 DOI: 10.1016/j.clinimag.2020.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/07/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
Image-guided core needle biopsy (CNB) is the standard of care procedure for tissue diagnosis of suspicious breast lesions. While complications are exceedingly rare, the most common complications include bleeding and hematoma formation. With an increasing number of patients on anticoagulation therapy (AT), it is important to determine whether continuation of these medications during CNB increases bleeding risk. While previous studies have demonstrated the safety in continuation of AT during CNB, American College of Radiology (ACR) guidelines recommend practitioners decide whether cessation is necessary on a case-by-case basis as this may put patients at risk for thromboembolic events. The purpose of this review is to analyze the literature on anticoagulation and bleeding risk during CNB to guide clinical practice.
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Affiliation(s)
- Paige McMahon
- Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA.
| | - Melissa Reichman
- Weill Cornell Medicine, Department of Radiology, 525 East 68th street, New York, NY 10065, USA.
| | - Katerina Dodelzon
- Weill Cornell Medicine, Department of Radiology, 525 East 68th street, New York, NY 10065, USA.
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14
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Onuigbo MAC, Sharma V, Balogun O, Ghimire A. Page Kidney Complicating Kidney Biopsy after Stopping Apixaban: A Physician's Dilemma. Indian J Nephrol 2020; 30:201-203. [PMID: 33013072 PMCID: PMC7470205 DOI: 10.4103/ijn.ijn_269_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/05/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022] Open
Abstract
Page kidney was described by Page, following very elaborate experiments with animal kidneys in 1939, with persistent arterial hypertension from "cellophane perinephritis." Subsequently, it was reported after trauma, from renal cysts and tumors, and from intrarenal hematoma complicating percutaneous kidney biopsy. We describe Page kidney associated with acute kidney injury 26 days after an uncomplicated ultrasound-guided right native kidney biopsy. Patient was on Apixaban, a non-vitamin K antagonist oral anticoagulant (NOAC) for atrial fibrillation which was withheld 3 days before the procedure. It was restarted 3 days after. The evidence-base supporting guidelines and recommendations for the peri-procedural management of the NOACs is inadequate, sparse, and often conflicted. More research is warranted.
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Affiliation(s)
- Macaulay A C Onuigbo
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Vivek Sharma
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Omotola Balogun
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Allina Ghimire
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
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15
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Seager M, Kumar S, Lim E, Munneke G, Bandula S, Walkden M. Renal cryoablation - a practical guide for interventional radiologists. Br J Radiol 2020; 94:20200854. [PMID: 32960674 DOI: 10.1259/bjr.20200854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Renal cryoablation is a treatment option for early stage renal cell carcinomas with excellent oncological outcomes and low morbidity. This review outlines the technique of renal cryoablation and provides a guide for interventional radiologists on setting up an integrated service within a renal cancer network multidisciplinary setting. Patient selection and preparation, together with the technical aspects which ensure optimal oncological outcomes and avoid collateral damage to adjacent organs are highlighted.
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Affiliation(s)
- Matthew Seager
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Shankar Kumar
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.,Centre for Medical Imaging, University College London, London, UK
| | - Emma Lim
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Graham Munneke
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Steve Bandula
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.,Centre for Medical Imaging, University College London, London, UK
| | - Miles Walkden
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
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16
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Lee MS, Moon MH, Kim CK, Park SY, Choi MH, Jung SI. Guidelines for Transrectal Ultrasonography-Guided Prostate Biopsy: Korean Society of Urogenital Radiology Consensus Statement for Patient Preparation, Standard Technique, and Biopsy-Related Pain Management. Korean J Radiol 2020; 21:422-430. [PMID: 32193890 PMCID: PMC7082664 DOI: 10.3348/kjr.2019.0576] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/12/2019] [Indexed: 11/15/2022] Open
Abstract
The Korean Society of Urogenital Radiology (KSUR) aimed to present a consensus statement for patient preparation, standard technique, and pain management in relation to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) to reduce the variability in TRUS-Bx methodologies and suggest a nationwide guideline. The KSUR guideline development subcommittee constructed questionnaires assessing prebiopsy anticoagulation, the cleansing enema, antimicrobial prophylaxis, local anesthesia methods such as periprostatic neurovascular bundle block (PNB) or intrarectal lidocaine gel application (IRLA), opioid usage, and the number of biopsy cores and length and diameter of the biopsy needle. The survey was conducted using an Internet-based platform, and responses were solicited from the 90 members registered on the KSUR mailing list as of 2018. A comprehensive search of relevant literature from Medline database was conducted. The strength of each recommendation was graded on the basis of the level of evidence. Among the 90 registered members, 29 doctors (32.2%) responded to this online survey. Most KSUR members stopped anticoagulants (100%) and antiplatelets (76%) one week before the procedure. All respondents performed a cleansing enema before TRUS-Bx. Approximately 86% of respondents administered prophylactic antibiotics before TRUS-Bx. The most frequently used antibiotics were third-generation cephalosporins. PNB was the most widely used pain control method, followed by a combination of PNB plus IRLA. Opioids were rarely used (6.8%), and they were used only as an adjunctive pain management approach during TRUS-Bx. The KSUR members mainly chose the 12-core biopsy method (89.7%) and 18G 16-mm or 22-mm (96.5%) needles. The KSUR recommends the 12-core biopsy scheme with PNB with or without IRLA as the standard protocol for TRUS-Bx. Anticoagulants and antiplatelet agents should be discontinued at least 5 days prior to the procedure, and antibiotic prophylaxis is highly recommended to prevent infectious complications. Glycerin cleansing enemas and administration of opioid analogues before the procedure could be helpful in some situations. The choice of biopsy needle is dependent on the practitioners' situation and preferences.
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Affiliation(s)
- Myoung Seok Lee
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Min Hoan Moon
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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17
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Low Utility of Screening Hematologic Testing for Image-Guided Biopsies in Patients Without Bleeding Risks. AJR Am J Roentgenol 2020; 215:1279-1285. [PMID: 32901565 DOI: 10.2214/ajr.19.22414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This study evaluates the prevalence of an abnormal international normalized ratio (INR) and platelet count before image-guided percutaneous needle biopsies over a 10-year period, comparing data from patients with and those without known conditions predisposing to coagulopathy. MATERIALS AND METHODS. A review of electronic medical records identified patients who were scheduled for a biopsy in a single institution's radiology department for the period of 2007-2016. The following information was recorded: demographic data, patient history of conditions that predispose to bleeding (e.g., liver disease, anticoagulant therapy, history of coagulopathy), and INR and platelet values within 30 days before biopsy. Data were stratified by biopsies that were performed versus those that were cancelled. RESULTS. Over 10 years, 3864 percutaneous biopsies were performed, and 6371 were cancelled. Approximately half of the biopsies (48.2%) were performed in patients without a predisposing condition; of those patients, 0.8% and 0.1% had an INR greater than 1.5 and greater than 1.8, respectively, and 0.4% had a platelet count of 50,000/μL or less (≤ 50 × 109/L). In patients with no known predisposing condition, 0.6% and 0.0% of biopsies cancelled were in patients who had an INR greater than 1.5 and greater than 1.8, respectively, and 0.1% of biopsies cancelled were in patients who had a platelet count of 50,000/μL or less. Ordering prebiopsy testing of patients with no predisposing conditions for the 1864 percutaneous biopsies performed over the 10-year study period resulted in more than $850,000 in laboratory-related health care costs. Our results suggest that the cost of identifying one abnormal INR is nearly $700,000. CONCLUSION. For patients without any known bleeding risks who are scheduled to undergo image-guided percutaneous biopsies, identifying an abnormal INR or abnormal platelet count is rare. Eliminating this testing in patients without predisposing conditions has the potential to create savings in costs and time for both physicians and patients.
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18
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Warhadapande S, Dariushnia SR, Kokabi N, O'Connell WG, Newsome JM, Findeiss LK, Majdalany BS. Clinical Approach to and Work-up of Bleeding Patients. Semin Intervent Radiol 2020; 37:24-30. [PMID: 32139967 DOI: 10.1055/s-0039-3402017] [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: 10/24/2022]
Abstract
A bleeding patient is a common consult for interventional radiologists. Prompt triage, preprocedural evaluation specific to the site of hemorrhage, and knowledge of resuscitative strategies allow for a potentially life-saving procedure to be appropriately and safely performed. Having a firm understanding of the clinical work-up and management of a bleeding patient has never been more important. In this article, a discussion of the clinical approach and work-up of a bleeding patient for whom interventional radiology is consulted is followed by a discussion of etiology-specific preprocedural work-up.
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Affiliation(s)
- Shantanu Warhadapande
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sean R Dariushnia
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Nima Kokabi
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - William G O'Connell
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Janice M Newsome
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Laura K Findeiss
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Bill S Majdalany
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
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19
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Bick U, Trimboli RM, Athanasiou A, Balleyguier C, Baltzer PAT, Bernathova M, Borbély K, Brkljacic B, Carbonaro LA, Clauser P, Cassano E, Colin C, Esen G, Evans A, Fallenberg EM, Fuchsjaeger MH, Gilbert FJ, Helbich TH, Heywang-Köbrunner SH, Herranz M, Kinkel K, Kilburn-Toppin F, Kuhl CK, Lesaru M, Lobbes MBI, Mann RM, Martincich L, Panizza P, Pediconi F, Pijnappel RM, Pinker K, Schiaffino S, Sella T, Thomassin-Naggara I, Tardivon A, Ongeval CV, Wallis MG, Zackrisson S, Forrai G, Herrero JC, Sardanelli F. Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imaging 2020; 11:12. [PMID: 32025985 PMCID: PMC7002629 DOI: 10.1186/s13244-019-0803-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/10/2019] [Indexed: 12/13/2022] Open
Abstract
We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as "high-risk" or B3 lesions). Finally, seven frequently asked questions are answered.
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Affiliation(s)
- Ulrich Bick
- Clinic of Radiology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Rubina M Trimboli
- PhD Course in Integrative Biomedical Research, Department of Biomedical Science for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
| | - Alexandra Athanasiou
- Breast Imaging Department, MITERA Hospital, 6, Erithrou Stavrou Str. 151 23 Marousi, Athens, Greece
| | - Corinne Balleyguier
- Department of Radiology, Gustave-Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Boris Brkljacic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Luca A Carbonaro
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Enrico Cassano
- Breast Imaging Division, European Institute of Oncology, Milan, Italy
| | - Catherine Colin
- Radiology Unit, Hospices Civils de Lyon, Centre Hospitalo-Universitaire Femme Mère Enfant, 59 Boulevard Pinel, 69 677, Bron Cedex, France
| | - Gul Esen
- School of Medicine, Department of Radiology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Andrew Evans
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Tom McDonald Avenue, Dundee, UK
| | - Eva M Fallenberg
- Diagnostic and Interventional Breast Imaging, Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael H Fuchsjaeger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Michel Herranz
- CyclotronUnit, GALARIA-SERGAS, Nuclear Medicine Department and Molecular ImagingGroup, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain
| | - Karen Kinkel
- Institut de Radiologie, Clinique des Grangettes, Chemin des Grangettes 7, 1224 Chêne-Bougeries, Genève, Switzerland
| | - Fleur Kilburn-Toppin
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Fundeni Institute, Bucharest, Romania
| | - Marc B I Lobbes
- Department of Radiology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, PO Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Laura Martincich
- Unit of Radiodiagnostics ASL AT, Via Conte Verde 125, 14100, Asti, Italy
| | - Pietro Panizza
- Breast Imaging Unit, Scientific Institute (IRCCS) Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Sorbonne Université, APHP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Anne Tardivon
- Department of Radiology, Institut Curie, Paris, France
| | - Chantal Van Ongeval
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthew G Wallis
- Cambridge Breast Unit and NIHR Biomedical Research Unit, Box 97, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | | | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. .,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
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20
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Velayudhan V, Patel S, Danziger A, Grigorian A, Waite S, Efendizade A. Transforaminal lumbar puncture for intrathecal access: Case series with literature review and comparison to other techniques. J Clin Neurosci 2020; 72:114-118. [PMID: 31980274 DOI: 10.1016/j.jocn.2019.12.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/30/2019] [Indexed: 11/30/2022]
Abstract
Fluoroscopic-guided lumbar puncture (LP) is a procedure commonly performed by radiologists, which in some circumstances may be difficult or impossible using a traditional posterior interspinous or interlaminar approach. Alternatives to LP include cervical and cisternal punctures, placement of an Ommaya reservoir, and lumbar laminectomy. More recently, however, there has been a move toward access of the thecal sac through a transforaminal approach in patients with challenging anatomy. This report outlines our approach and experience using transforaminal LP (TFLP) in patients with spinal muscular atrophy (SMA) with a 100% success rate. We discuss its utility in other patients with difficult access and compare TFLP with other techniques to access the intrathecal space.
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Affiliation(s)
- Vinodkumar Velayudhan
- Department of Diagnostic Radiology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United States.
| | - Suraj Patel
- Department of Diagnostic Radiology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Andrew Danziger
- Department of Neurosurgery, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, United States
| | - Arcadi Grigorian
- Department of Diagnostic Radiology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Stephen Waite
- Department of Diagnostic Radiology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Aslan Efendizade
- Department of Diagnostic Radiology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
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21
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Dolan RS, Goldman D, El-Deiry M, Kokabi N, Bercu ZL, Newsome J, Martin JG. Image-Guided Percutaneous Gastrostomy Tube Placement is Safe in Patients Requiring Aspirin 325 mg. Acad Radiol 2019; 26:1483-1487. [PMID: 30878344 DOI: 10.1016/j.acra.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/08/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
RATIONALE AND OBJECTIVES Requests for gastrostomy tube placement in patients on aspirin (ASA) 325 mg are common, particularly in patients following reconstructive surgery for head and neck cancer, but periprocedural guidelines and recommendations regarding management of high dose aspirin are inconsistent. The purpose of this study was to assess the bleeding risk of percutaneous gastrostomy tube placement in patients on ASA 325 mg. MATERIALS AND METHODS This retrospective study of 213 patients who underwent image-guided "push" percutaneous gastrostomy tube placement compared rates of significant bleeding and other secondary outcomes (including all-cause mortality within 30 days, procedure-related mortality, bowel perforation, abdominal abscess, peritonitis, aspiration pneumonia, intraprocedural airway complications, and tube dislodgement) between patients maintained on ASA 325 mg and patients not on antiplatelet or anticoagulation therapy. RESULTS No significant bleeding episodes occurred in patients on ASA 325 mg, compared to three episodes in patients not on ASA 325 mg (p = 0.37). A patient in each group had aspiration pneumonia possibly related to tube placement. There were no other notable secondary outcomes, including intraprocedural airway complications in this population with complex head and neck anatomy. CONCLUSION These findings suggest that holding ASA 325 mg in patients undergoing percutaneous gastrostomy tube placement is not necessary, especially in patients in whom holding ASA would pose considerable risk. Further multi-institutional longitudinal study is warranted to validate these results.
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22
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A Guided Survey Approach for Joint Commission Preparedness in Radiology. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0339-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Dalag L, Fergus JK, Zangan SM. Lung and Abdominal Biopsies in the Age of Precision Medicine. Semin Intervent Radiol 2019; 36:255-263. [PMID: 31435134 DOI: 10.1055/s-0039-1693121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Image-guided percutaneous needle biopsies (PNBs) are one of the most common procedures performed in radiology departments today. Rapid developments in precision medicine, which identifies molecular and genomic biomarkers in cancers, have ushered a new paradigm of oncologic workup and treatment. PNB has conventionally been used to establish a benign or malignant nature of a lesion during initial diagnosis or in suspected metastatic or recurrent disease. However, increasing amounts of tissue are being required to meet the demands of molecular pathologic analysis, which are now being sought at multiple time points during the course of the disease to guide targeted therapy. As primary providers of biopsy, radiologists must be proactive in these developments to improve diagnostic yield and tissue acquisition in PNB. Herein, we discuss the important and expanding role of PNB in the age of precision medicine and review the technical considerations of percutaneous lung and intra-abdominal biopsy. Finally, we examine promising state-of-the-art techniques in PNB that may safely increase tissue acquisition for optimal molecular pathologic analysis.
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Affiliation(s)
- Leonard Dalag
- Department of Radiology, University of Chicago, Chicago, Illinois
| | | | - Steven M Zangan
- Department of Radiology, University of Chicago, Chicago, Illinois
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24
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Özütemiz C, Rykken JB. Lumbar puncture under fluoroscopy guidance: a technical review for radiologists. ACTA ACUST UNITED AC 2019; 25:144-156. [PMID: 30774095 DOI: 10.5152/dir.2019.18291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There are many differences in fluoroscopy-guided lumbar puncture (FG-LP) technique among radiologists. Even within the same institution, there are a variety of preferences among proceduralists with individual perspectives based on the literature, training, and/or experience. Our aim is to provide familiarity with various techniques involved in FG-LP and provide insight on how to improve patient outcomes. The pertinent anatomy and physiology, indications, contraindications, patient management, complications of the procedure, and procedural techniques for performing an FG-LP are reviewed in detail. Potentially controversial topics regarding FG-LP are also addressed. There are many differences in fluoroscopy-guided lumbar puncture (FG-LP) technique among radiologists (1). Even within the same institution, there are a variety of individual preferences among physicians with different perspectives based on a combination of literature familiarity, training, and personal experience. Our aim is to provide familiarity with various techniques involved in FG-LP, improve efficiency, and improve patient outcomes. We will also address possible controversial issues regarding FG-LPs using an evidence-based approach.
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Affiliation(s)
- Can Özütemiz
- Department of Radiology, University of Minnesota, School of Medicine, Minneapolis, MN, USA
| | - Jeffrey B Rykken
- Department of Radiology, University of Minnesota, School of Medicine, Minneapolis, MN, USA
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Herman DD, Thomson CC, Brosnhan S, Patel R, Trosini-Desert V, Bilaceroglu S, Poston JT, Liberman M, Shah PL, Ost DE, Chatterjee R, Michaud GC. Risk of bleeding in patients undergoing pulmonary procedures on antiplatelet or anticoagulants: A systematic review. Respir Med 2019; 153:76-84. [PMID: 31176274 DOI: 10.1016/j.rmed.2019.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/28/2019] [Indexed: 01/22/2023]
Abstract
As many as 25% of all patients undergoing invasive pulmonary procedures are receiving at least one antiplatelet or anticoagulant agent. For those undergoing elective procedures, the decision-making process is uncomplicated and the procedure may be postponed until the antiplatelet or anticoagulant agent may be safely held. However, many invasive pulmonary procedures are semi-elective or emergent in nature in which case a risk-benefit calculation and discussion occur between the provider and patient or surrogate decision-maker. Therefore, it is critical for providers to have an awareness of the risk of bleeding complications with different pulmonary procedures on various antiplatelet and anticoagulant agents. This systematic review summarizes the bleeding complications associated with different pulmonary procedures in patients on various antiplatelet or anticoagulant agents in the literature and reveals a paucity of high-quality evidence across a wide spectrum of pulmonary procedures and antiplatelet or anticoagulant agents. The results of this review can help inform providers of the bleeding risk in these patients to aid in the shared decision-making process and risk vs benefit discussion.
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Affiliation(s)
- D D Herman
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ohio State University, 201L Dorothy M. Davis Heart & Lung Research Institute, 473W. 12th Avenue, Columbus, OH, 43210, USA.
| | - C C Thomson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Auburn Hospital, 300 Mt Auburn St #419, Cambridge, MA, 02138, USA
| | - S Brosnhan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, NYU Lagone Health, 550 1st, Avenue New York, New York, 10016, USA
| | - R Patel
- Departments of Critical Care Medicine and Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, USA
| | - V Trosini-Desert
- Service de Pneumologie et Réanimation, Unité d'Endoscopie Bronchique, Groupe Hospitalier Pitié Salpétrière, 7 Avenue de la République, 94200, Ivry-sur-Seine, France
| | - S Bilaceroglu
- Department of Pulmonary Medicine, Izmir Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, Health Sciences University, 35110, Yenisehir, Izmir, Turkey
| | - J T Poston
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - M Liberman
- Division of Thoracic Surgery, CHUM Endoscospic Tracheobronchial and Oesophageal Center, Department of Surgery, University of Montreal, 1560 rue Sherbrooke Est 8e CD - Pavillon Lachapelle, Bureau D, 8051, Montréal, Québec, H2L 4M1, Canada
| | - P L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom National Heart & Lung Institute, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - D E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 853, Houston, TX, 77030,, USA
| | - R Chatterjee
- Brooke Army Medical Center, 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, Texas, 78234, USA
| | - G C Michaud
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, NYU Lagone Health, 530 1st Avenue, HCC, Suite 5D, New York, NY, 10016, USA
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A retrospective analysis of the periprocedural management of oral anticoagulants in patients undergoing interventional radiology procedures. J Thromb Thrombolysis 2018; 46:451-460. [DOI: 10.1007/s11239-018-1740-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Endobronchial Ultrasound (EBUS) for Staging Lung Cancer in the Elderly Population—Specific Procedural and Medication Issues. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Khadra H, Kholmatov R, Monlezun D, Kandil E. Do anticoagulation medications increase the risk of haematoma in ultrasound-guided fine needle aspiration of thyroid lesions? Cytopathology 2018; 29:565-568. [PMID: 29969159 DOI: 10.1111/cyt.12608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/18/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND A feared complication of thyroid fine needle aspiration (FNA) is bleeding diathesis and haematoma at the biopsy site. Patients are often advised to discontinue antithrombotic/anticoagulant (AT/AC) medications prior to the procedure. The aim of this study was to examine the risk of bleeding in patients on AT/AC medications undergoing cervical ultrasound (US)-guided FNA. METHODS A retrospective chart review of 803 patients who underwent US-guided FNA of thyroid nodules over 8 years by a single endocrine surgeon was undertaken. Clinical variables, patient demographics and use of AT/AC medications were collected and analysed. The principle outcome measures included the incidence of procedure-related haematoma formation. Multivariable logistic regression was used to investigate the possible independent association between post-FNA haematoma and anticoagulation, adjusting for age, African American race, body mass index, vascularity and lesion size. RESULTS A total of 1568 lesions were included in 803 patients. The mean age for the patients on AT/AC was 63.0 ± 10.4 years and those not on AT/AC was 50.1 ± 14.2 years (P < 0.001). Of those, 148 patients had 336 lesions (21%) biopsied while taking one or more daily AT/AC agent (81 patients: aspirin; 11 patients: Plavix; 17 patients: aspirin and warfarin; 30 patients: aspirin and Plavix; seven patients: rivaroxaban and aspirin; and two patients: ticagrelor and aspirin). Three patients (0.89%) in the AT/AC group compared to six patients (0.49%) not receiving AT/AC medications developed a haematoma (P = 0.41). All complications were treated conservatively and none required intervention. CONCLUSIONS US-guided FNA of thyroid lesions can be safely performed on patients taking AT/AC including newer agents, without an increase in adverse outcomes or decreased diagnostic rate. Further larger prospective multi-institutional studies are warranted to further investigate this important finding.
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Affiliation(s)
- Helmi Khadra
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Roostam Kholmatov
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Dominique Monlezun
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Flagg ER, Henry TS, Elicker BM, Kallianos KG, Ordovas KG, Naeger DM. Periprocedural Management in Transthoracic Needle Biopsy: Review of the Current Evidence. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0274-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications. IRANIAN JOURNAL OF RADIOLOGY 2018. [DOI: 10.5812/iranjradiol.57231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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O'Connell W, Shah J, Mitchell J, Prologo JD, Martin L, Miller MJ, Martin JG. Obstruction of the Biliary and Urinary System. Tech Vasc Interv Radiol 2017; 20:288-293. [PMID: 29224663 DOI: 10.1053/j.tvir.2017.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Biliary and urinary obstructions can be managed endoscopically or cystoscopically, surgically or by percutansous intervention or drainage. If the obtructed system is infected, emergent decompression is needed. Early recognition and treatment is paramount in both conditions. Acute cholangitis can present many different ways, from mild symptoms to fulminant sepsis. It is usually a result of ascending bacterial colonization and biliary obstruction resulting in bacterial overgrowth. Therefore, those patients with recent biliary instrumentation or previous biliary modification are at higher risk. Charcot's triad of fever, right upper quadrant abdominal pain, and jaundice is only seen in 50%-70% of patients. Fever is seen in over 90% of cases, pain is seen in 70% of cases, and jaundice is seen in 60% of cases. Altered mental status and hypotension are associated with severe cases. All 5 symptoms of fever, right upper quadrant abdominal pain, jaundice, altered mental status, and hypotension are referred to as Reynold's Pentad. Acute pyonephrosis can also present many different ways, from minimal symptoms to fulminant sepsis. Fever, chills, and flank pain are the classic symptoms, although some patients may be relatively asymptomatic. Pyonephrosis may present with a classic triad of fever, flank pain, and hydronephrosis, or simply hydronephrosis and sepsis. Pyonephrosis usually occurs as a result of urinary obstruction with either an ascending infection of the urinary tract or hematogenous spread of a bacterial pathogen as the culprit. Up to 75% of cases are related to urinary stone disease. Patients are at increased risk for pyonephrosis when they haven anatomic urinary tract obstruction, certain chronic diseases (diabetes meliitus and AIDS), or are immunosuppressed due to immunodeficiency or medications, (chronic steroid therapy).
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Affiliation(s)
- William O'Connell
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA. william.o'
| | - Jay Shah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Jason Mitchell
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - J David Prologo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Louis Martin
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Michael J Miller
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Jonathan G Martin
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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Marcelin C, Ambrosetti D, Bernhard J, Roy C, Grenier N, Cornelis F. Percutaneous image-guided biopsies of small renal tumors: Current practice and perspectives. Diagn Interv Imaging 2017; 98:589-599. [DOI: 10.1016/j.diii.2017.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 12/30/2022]
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Vollmer Torrubiano I, Sánchez González M. Interventional procedures in the chest. RADIOLOGIA 2016; 58 Suppl 2:15-28. [PMID: 27091550 DOI: 10.1016/j.rx.2016.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 02/03/2023]
Abstract
Many thoracic conditions will require an interventional procedure for diagnosis and/or treatment. For this reason, radiologists need to know the indications and the technique for each procedure. In this article, we review the various interventional procedures that radiologists should know and the indications for each procedure. We place special emphasis on the potential differences in the diagnostic results and complications between fine-needle aspiration and biopsy. We also discuss the indications for radiofrequency ablation of lung tumors and review the concepts related to the drainage of pulmonary abscesses. We devote special attention to the management of pleural effusion, covering the indications for thoracocentesis and when to use imaging guidance, and to the protocol for pleural drainage. We also discuss the indications for percutaneous treatment of pericardial effusion and the possible complications of this treatment. Finally, we discuss the interventional management of mediastinal lesions and provide practical advice about how to approach these lesions to avoid serious complications.
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Abstract
Determining practice parameters for interventional procedures is challenging due to many factors including unreliable laboratory tests to measure bleeding risk, variable usage of standardized terminology for adverse events, poorly defined standards for administration of blood products, and the growing numbers of anticoagulant and antiplatelet medications. We aim to address these and other issues faced by radiologists performing invasive procedures through a review of available literature, and experiential guidance from three academic medical centers. We discuss the significant limitations with respect to using prothrombin-time and international normalized ratio to measure bleeding risk, especially in patients with synthetic defects due to liver function. Factors affecting platelet function including the impact of uremia; recent advances in laboratory testing, including platelet function testing; and thromboelastography are also discussed. A review of the existing literature of fresh-frozen plasma replacement therapy is included. The literature regarding comorbidities affecting coagulation including malignancy, liver failure, and uremia are also reviewed. Finally, the authors present a set of recommendations for laboratory thresholds, corrective transfusions, as well as withholding and restarting medications.
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