American Journal of Interventional Radiology

1-4

Authors: James Ryan Loftus

The transdiscal approach has been described for nerve block and neurolysis of the hypogastric and celiac plexuses for chronic pain relief; however reports utilizing transdiscal approach for biopsy of aortocaval lymph nodes or other retroperitoneal masses are scarce. Traditional posterior paravertebral, lateral, or anterior approaches are often not technically feasible for core biopsy of aortocaval lesions due overlying bowel, organs, or vessels. In aortocaval or other retroperitoneal lesions inaccessible by traditional techniques the transdiscal method is invaluable in providing a linear approach that avoids the major vessels, organs, and bowel and allows for core biopsy. This case report demonstrates the use of transdiscal approach for core biopsy of aortocaval lesions otherwise inaccessible by traditional approaches

1-6

Authors: Melissa F Perkal

Objective: To retrospectively analyze the treatment outcomes of male patients who underwent emergent percutaneous cholecystostomy (PC) for biliary decompression in acute cholecystitis. Methods: A single-institution retrospective analysis of 132 patients from 2003 to 2013. Outcome measures were survival, cholecystostomy drain outcomes, and definitive treatment with surgical cholecystectomy. Results: The patient population was all male, with a mean age of 70.6 years. 79 patients (59.9%) were admitted for biliary disease and 34 patients (25.8%) were in an intensive care unit (ICU) when diagnosed. 18 patients (13.6%) died within 30 days of PC, an additional 12 (9%) died within 6 months of PC, and the median survival was 4.9 years. Multivariate logistic regression showed a direct relationship between 1 month and 6-month mortality with total bilirubin and an inverse relationship with hematocrit. Cox regression analysis for long-term survival revealed increased mortality associated with respiratory failure (hazard ratio [HR]: 2.40, P = 0.023) and total bilirubin (HR: 1.11, P < 0.001); lower mortality was associated with a primary diagnosis of cholecystitis (HR: 0.29, P = 0.010), higher hematocrit (HR: 0.89, P < 0.001), and ICU (HR: 0.17, P = 0.003) and floor (HR: 0.34, P = 0.029) diagnosis location. Only 55 patients (41.7%) proceeded to surgical cholecystectomy. Outcomes at 1 year (n = 110) were 40% alive after surgery, 25.5% alive without surgery or a drain, 2.7% alive without surgery but with a drain, and 31.8% dead. Conclusions: Although PC is associated with a high early mortality, 25.5 % of our patients were definitively treated with cholecystostomy alone. Certain biomarkers and patient characteristics may help model survival after PCient characteristics may help model survival after PC

1-3

Authors: Redi Rahmani

Intraventricular hemorrhage (IVH) remains a significant cause of morbidity and mortality. Intraventricular alteplase is a recently established therapy, with the clot lysis: Evaluating accelerated resolution of IVH (CLEAR) III trial, being the highest level evidence to date. Historically, as in the CLEAR III trial, there have been notable exclusionary criteria for patients to receive this therapy. The goal of this report is to demonstrate its safe use in a patient with moyamoya. We present a 60-year-old male with severe IVH secondary to moyamoya disease successfully treated with intraventricular alteplase.

1-5

Authors: David Maldow

Education is evolving in the field of interventional radiology. Technical skills are no longer the primary focus of training, while a stronger emphasis is placed on longitudinal patient care. Interventional radiologists are now expected to perform rounds on their patients in the hospital and promote continuity of care in the outpatient setting (Murphy et al. Semin Intervent Radiol 2005;22:6-9). The recent establishment of residency programs in interventional radiology (RPIR) aims to foster this transition by integrating clinical rotations such as the intensive care unit and expanding resident time in the clinic (Siragusa et al. J Vasc Interv Radiol 2013;24:1609-12). With the new training model comes a greater need for early exposure of medical students to the field, as trainees now apply for RPIR during their 4th year of medical school. To address this issue, interventional radiology interest groups (IRIGs) have been developed by passionate students with a desire to educate their colleagues and further their own knowledge of IR. IRIGs inform medical students about the specialty through unique activities such as hands-on device workshops and information sessions. In coordination with supportive advisors, IRIGs play a vital role in recruiting talented trainees, many of whom may well become the next leaders of our field. This article will discuss the process of starting an IRIG and how to maximize available resources to foster its success.

1-7

Authors: Jacqueline Murtha

Sepsis is frequently encountered in the hospital setting and can be community-acquired, health-care-associated, or hospital-acquired. The annual incidence of sepsis in the United States population ranges from 300 to 1031 per 100,000 and is increasing by 13% annually. There is an associated inhospital mortality of 10% for sepsis and >40% for septic shock. Interventional radiology is frequently called on to treat patients with sepsis, and in rarer circumstances, interventional radiologists themselves may cause sepsis. Thus, it is essential for interventional radiologists to be able to identify and manage septic patients to reduce sepsis-related morbidity and mortality. The purpose of this paper is to outline procedures most likely to cause sepsis and delineate important clinical aspects of identifying and managing septic patients.