Endovascular management of porto-mesenteric venous thrombosis developing after trans-arterial occlusion of a superior mesenteric arteriovenous fistula.

Porto-mesenteric venous thrombosis following a trans-arterial occlusion of a superior mesenteric arteriovenous fistula is a rare occurrence. We present a case of endovascular management of one such case treated pharmacomechanically with catheter-directed mesenteric thrombolysis and transjugular intrahepatic portosystemic shunt creation without long-term successful outcome.

Improving the tracking and removal of retrievable inferior vena cava filters.

Therapeutic and prophylactic inferior vena cava (IVC) filters should be placed based on currently accepted indications to prevent a fatal pulmonary embolism (PE). The protective effect of filters is offset by the potential for lower extremity deep venous thrombosis (DVT), caval thrombosis, and possible otherwise unnecessary life-long anticoagulation (AC). The duration of treatment for most DVTs or PEs is 3 to 6 months of AC/filter. Filters should be retrieved when duration of treatment for a DVT/PE has been met, the risk of a PE is no longer high, and/or there is no longer a contraindication to AC. An effective system that leads to improving the retrieval rate of filters must include education of the patient, a tracking system to minimize patient lost to follow-up, and dedicated personnel to oversee the process. If these goals are accomplished, interventionalists can help decrease the incidence of a fatal PE during the high-risk period, and also decrease the risk of a DVT or the use of otherwise unnecessary life-long AC in subsequent years. Currently, there is much room for improvement in the frequency that IVCF patients are systematically followed and filters are retrieved. The principles discussed in this report will be helpful in this process.

Medical management in peripheral arterial disease: a systematic approach to medical therapy.

The American College of Cardiology/American Heart Association 2005 Guidelines for the Management of Patients with Peripheral Arterial Disease (PAD) emphasize the importance of cardiovascular risk reduction in all patients with PAD as a result of the high likelihood of coexisting atherosclerotic disease of the peripheral, coronary, and cerebral circulations. The guidelines outline the clear and definite role for antiplatelet, lipid-lowering, and antihypertensive drugs as well as adequate diabetic control. All practicing interventional radiologists should be familiar with these practical and useful guidelines, as well as the rationale for use of each of these medications.

Evaluation and management of the trauma patient for the interventional radiologist.

Interventional radiologists are adopting an increasingly important role in the evaluation and management of the acutely injured patient. The interventional radiologist may be called upon to provide services while hemorrhage is active, the patient is hemodynamically compromised, and a comprehensive trauma assessment is incomplete. The initial diagnostic and management approach to the trauma patient is optimally organized through the principles of advanced trauma life support. A basic understanding of common injury patterns, immediate lifesaving interventions, and principles of resuscitation is of value to the interventional radiologist in his or her interactions with the trauma team and contribution to patient care.

Tips and tricks for the trauma patient.

Interventions on the trauma patient are an essential component of the complete scope of care that is provided to the multiply injured patient today. The active participation by the interventional radiologist along the entire spectrum of clinical care is very important to optimize patient outcomes. Suggestions on how to establish a clinical presence are presented. A few of the newer concepts and terminology applicable to trauma care are reviewed. Tips useful in the trauma room, in the interventional radiology suite, and during the postprocedural period are discussed.