Applied Interventional Radiology

Simplicity Is the Essence of Success!

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Trainees in Interventional Radiology - 1. Does the potential benefit to the patient from the procedure outweigh the risk? 2. Is there a lower risk alternative which can achieve the same benefit? 3. What could go wrong? 4. How will I manage any complication? Remember, nothing is ever routine. #appliedir #appliedinterventionalradiology #interventionalradiology #radiology #withoutascalpel #beprepared #youngdoctors #lifelonglearning #tanzania #tanzaniair https://www.instagram.com/p/B5dB2dqnz7b/?igshid=a3ncclqmuslu

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Interventional Radiology Tutorial: Gelfoam Pledgets for Hemostasis after Solid Organ Biopsy

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Spine Jack kyphoplasty of osteoporotic debilitation compression fracture of L2. Spine Jack (@strykercorporation) is the first product in years which has the potential to reduce adjacent fracture rates by legitimately restoring vertebral body height and and end plate configuration. #appliedibterventionalradiology #withoutascalpel #kyphoplasty #vertebroplasty #vertebralcompressionfracture #spinefracture #interventionalradiology #compressionfracture #osteoporosis https://www.instagram.com/p/Bvzsg_pHrhA/?utm_source=ig_tumblr_share&igshid=zu07uh4m7lnw

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Complications and Calamities - Cases to Stimulate Discussion. This one which was shared with me comes from the realm of percutaneous intrathoracic procedures. An elderly patient with a loculated pleural effusion underwent a diagnostic thoracentesis. CT image of the upper right chest are shown and depict a loculated effusion and extensive bronchiectasis (Image 1). Ultrasound images of the loculated pleural effusion both before and after the thoracentesis are also shown (Images 2 and 3). Shortly after the procedure he became unresponsive and CT of the head and neck was performed. These images are shown from caudal to cranial (Images 4-10). What do you see? How can this be explained? Could it have been predicted or prevented? What is the prognosis? #appliedir #appliedinterventionalradiology #interventionalradiology #withoutascalpel #pulmonology #embolism https://www.instagram.com/p/Bug_gZPHam6/?utm_source=ig_tumblr_share&igshid=11zynh41f9ck0

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DIPS in a complex patient with cirrhosis and gastric cancer with liver metastases. Patient had massive medication refractory ascites resulting in severe hypotension and renal malperfusion with subsequent renal failure. Ascites was proven non-malignant. TIPS from the right or middle hepatic veins was precluded by intervening tumors. TIPS was attempted from the left hepatic vein but because of uncorrectable hypovolemia the small size and tortuous origin of the left hepatic vein did not enable a stable platform and capsular perforation occurred (image 3). A DIPS was then performed. IVUS did not provide adequate visualization of the portal vein. The course of puncture was determined by review of cross-sectional Imaging (image 4). A curved needle was used to puncture through the wall of the IVC into the caudate branch of the portal vein. The tract was shorter than the shortest available Viabahn stent so a 4cm balloon expandable Atrium stent was deployed but failed to reverse flow or improve the gradient (image 9). A 5cm Viabahn was then deployed which resulted in an excellent result (final image 10). #appliedir #appliedinterventionalradiology #interventionalradiology #withoutascalpel #cirrhosis #ascites #gastriccancer #TIPSprocedure #DIPSprocedure #portalhypertension #gastroenterology #hepatology https://www.instagram.com/p/Bug_fhAntUE/?utm_source=ig_tumblr_share&igshid=1shqyc4uwfg18

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Coil Embolization of a pulmonary artery pseudoaneurysm. This pseudoaneurysm was caused by Swan-Ganz catheter placement during a cardiac catheterization case. The injury corresponds precisely to the location of the Swan-Ganz balloon. Rupture of pulmonary artery aneurysms and pseudoaneurysms is rare, but confers nearly 100% mortality. Embolization in this case requires sacrifice of the lateral basilar segmental artery. The patient tolerated Embolization well. Credit to @curtselser for this excellent case. Thanks Curt! #appliedir #appliedinterventionalradiology #interventionalradiology #withoutascalpel #pulmonaryartery #aneurysm #pseudoaneurysm #embolization #coil #cardiaccath #cardiology #pulmonology https://www.instagram.com/p/Bug_dmHns4Q/?utm_source=ig_tumblr_share&igshid=9x1ukw8qmqmf

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Microwave ablation of a solitary breast cancer metastasis to the lateral segment of the left lobe of the liver. The three month post ablation image on the lower right shows a complete response. #appliedir #appliedinterventionalradiology #ablation #breastcancer #microwave #metastasis #withoutascalpel #cancertreatment #minimallyinvasive #oncology https://www.instagram.com/p/BuglJW7HgFJ/?utm_source=ig_tumblr_share&igshid=1ju4zciks9k3o

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Acute iliac artery thrombosis in a 74 yo female smoker with a history of prior kissing iliac artery stents. The patient presented with acute onset cold painful right leg. Kissing balloon expandable covered stents were place within the existing stents resulting in raising the aortic bifurcation by about 1cm. Care was taken to preserve flow in the internal iliac arteries. A long residual stenosis of the right external iliac artery was treated with a drug coated balloon with good result. Patient’s symptoms resolved almost immediately and she was discharged the following day on dual antiplatelet therapy. #arterial #thromosis #VBX #iliac #stent #coveredstent #interventionalradiology #appliedir #appliedinterventionalradiology #withoutascalpel #angiography #arteriogram #coldleg #pad #peripheralarterialdisease https://www.instagram.com/p/BtteJ8YHtMW/?utm_source=ig_tumblr_share&igshid=uts47nf4lotr

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Retrieval of 11 year old IVC fIlter. Note the snare around the hook at the apex of the filter. The filter is deeply intimalized such that retraction on the snare resulted in straightening of the hook. Fortunately the hook held and the filter was removed successfully and in one piece. It was replaced with a new permanent filter because the patient had a history of multiple PE’s and DVT’s and lifelong contraindication to anticoagulation. #ivc #ivcfilter #dvt #pe #appliedir #appliedinterventionalradiology #withoutascalpel https://www.instagram.com/p/BtpdcJbnxY0/?utm_source=ig_tumblr_share&igshid=t4jbj7kicsk7

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Chronic Mesenteric Ischemia from Extrinsic Compression - Applied Interventional Radiology

Revascularization of the celiac artery and SMA for symptomatic chronic mesenteric ischemia resulting from extrinsic compression by a large carcinoid tumor.

Revascularization of the celiac artery and SMA for symptomatic chronic mesenteric ischemia resulting from extrinsic compression by a large carcinoid tumor.

[appliedinterventionalradiology]

Chronic Mesenteric Ischemia from Extrinsic Compression

Chronic Mesenteric Ischemia from Extrinsic Compression

Background

This is a 67-year-old female with a large retroperitoneal carcinoid tumor who began experiencing postprandial pain and weight loss approximately eight months prior. At that time she underwent angiography which revealed extrinsic compression of both the celiac artery and super mesenteric artery. These were stented which resulted in alleviation of her symptoms. Unfortunately, her…

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[appliedinterventionalradiology]

Not so much a question.... but I enjoy your blog. Your pictures are really awesome. I never did catch lab, but I used to do CT. I loved angio work and cardiac; the fast paced setting, the turnover time. Keep up the blog and the patient care :) Thank you.

Thank you!  I really appreciate that you took the time to write your kind words.  It made me smile.  I do love what I do and love to share it with others when I find the time.  Even after 10 years in practice, there’s not a dull day!  Keep spreading joy the way you do.  Peace and happy holidays!

[appliedinterventionalradiology]

Embolization of a Varicocele in a 38 yo male. The patient and his wife have had trouble conceiving despite a thorough fertility evaluation. Embolization was performed with foamed Sotradecol STS diluted to 1.5% in columns interrupted by detachable Ruby coils. #appliedir #appliedinterventionalradiology #urology #embolization #varicocele #withoutascalpel #fertility #interventionalradiology https://www.instagram.com/p/BrZcEPSl16Q/?utm_source=ig_tumblr_share&igshid=g7p1px8np08q

[appliedinterventionalradiology]

Fractured stent in the right subclavian vein in a patient with recurrent right upper extremity swelling. The patient, a young female boxer, experienced acute right subclavian vein stenosis two years prior and was treated at another institution with thrombolysis and stenting of the subclavian vein. First rib resection is the preferred approach due to the fact that stents perform poorly here because of severe repetitive extrinsic compression resulting in deformity, fracture and thrombosis as illustrated here. #appliedir #interventionalradiology #vascular #pagetschroettersyndrome #subclavianvein #dvt #thrombosis #radiology #angiography #vascularsurgery https://www.instagram.com/p/BoSq3jKl_BH/?utm_source=ig_tumblr_share&igshid=1b7ob2lbrxe9b

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A cool case of pulmonary microlithiasis in a 72 year old presenting with altered mental status (unrelated). #chest #radiology #pulmonary #microlithiasis #CT https://www.instagram.com/p/BoSo7gglRxd/?utm_source=ig_tumblr_share&igshid=1fvyq3kio3192

[appliedinterventionalradiology]

Massive abdominal tumor in middle aged woman who presented with abdominal distension and early satiety. Ultrasound guided biopsy revealed a GIST tumor. #appliedir #appliedinterventionalradiology #biopsy #gist #gastroenterology #radiology #ultrasound #biopsy #percutaneous https://www.instagram.com/p/Bnd0StiBEzR/?utm_source=ig_tumblr_share&igshid=jjsmux152chz

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8mm apical new pulmonary nodule with spiculated margins in a high risk smoker. Biopsy revealed acute inflammation and granulomatous tissue without any evidence of malignancy. #appliedir #appliedinterventionalradiology #radiology #pulmonology #biopsy #lungcancer https://www.instagram.com/p/Bndz2PjFr6c/?utm_source=ig_tumblr_share&igshid=i2p2kzzrriqd