ABSTRACT
The number of people worldwide living with end-stage renal disease is increasing. Arteriovenous fistulas are the preferred method of vascular access in patients who will require hemodialysis. As the number of patients with arteriovenous fistulas grows, the role of physicians who intervene who maintain and salvage these fistulas will grow in importance. This review aims to familiarize practitioners with the rationale for arteriovenous fistula creation, the detection of fistula dysfunction, and the state of the art on fistula maintenance and preservation. Current controversies are briefly reviewed.
Subject(s)
Arteriovenous Fistula , Arteriovenous Shunt, Surgical , Kidney Failure, Chronic , Arteriovenous Shunt, Surgical/adverse effects , Arteriovenous Shunt, Surgical/methods , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Renal Dialysis/methods , Vascular PatencyABSTRACT
As prostatic artery embolization is assuming an increasingly important role in the management of benign prostatic hyperplasia, it is important for the practicing interventional radiologist to have a deep understanding of all aspects of the disease process and the available treatment options. This paper provides a comprehensive overview of the pathophysiology, diagnosis and management options for benign prostatic hyperplasia with an emphasis on the surgical and medical treatments.
Subject(s)
Embolization, Therapeutic , Lower Urinary Tract Symptoms/therapy , Prostate/blood supply , Radiography, Interventional , Urologic Surgical Procedures, Male , Urological Agents/therapeutic use , Embolization, Therapeutic/adverse effects , Humans , Lower Urinary Tract Symptoms/diagnostic imaging , Lower Urinary Tract Symptoms/physiopathology , Male , Prostatic Hyperplasia/diagnostic imaging , Prostatic Hyperplasia/therapy , Radiography, Interventional/adverse effects , Treatment Outcome , Urologic Surgical Procedures, Male/adverse effects , Urological Agents/adverse effectsABSTRACT
A 66-year old woman had a left breast mass. Biopsy showed invasive ductal carcinoma. A PET/CT scan demonstrated hypermetabolism in the left breast and atypical heterogeneously increased uptake throughout the skeleton as well as a minimally FDG-avid right adrenal myelolipoma. PET/CT 4 months later after 6 cycles of neoadjuvant chemotherapy demonstrated increased size and FDG avidity of this adrenal mass concerning for metastasis and uniformly increased skeletal FDG avidity. Biopsy demonstrated adrenal myelolipoma. The growth and increased FDG avidity of the adrenal myelolipoma were due to the action of colony-stimulating factors on the tumor's hematopoietic component.
Subject(s)
Adrenal Gland Neoplasms/diagnosis , Adrenal Gland Neoplasms/physiopathology , Breast Neoplasms/pathology , Hematopoiesis , Myelolipoma/diagnosis , Myelolipoma/physiopathology , Adrenal Gland Neoplasms/diagnostic imaging , Aged , Diagnosis, Differential , Female , Fluorodeoxyglucose F18 , Humans , Myelolipoma/diagnostic imaging , Neoplasm Metastasis , Positron Emission Tomography Computed TomographyABSTRACT
PURPOSE: Catheter-directed thrombolysis (CDT) is a relatively new therapy for pulmonary embolism that achieves the superior clot resolution compared to systemic thrombolysis while avoiding the high bleeding risk intrinsically associated with that therapy. In order to examine the efficacy and safety of CDT, we conducted a retrospective cohort study of patients undergoing ultrasound-assisted CDT at our institution. METHODS: The charts of 30 consecutive patients who underwent CDT as a treatment of pulmonary embolism at our institution were reviewed. Risk factors for bleeding during thrombolysis were noted. Indicators of the right heart strain on computed tomography and echocardiogram, as well as the degree of pulmonary vascular obstruction, were recorded before and after CDT. Thirty-day mortality and occurrence of bleeding events were recorded. RESULTS: Nine (30%) patients had 3 or more minor contraindications to thrombolysis and 14 (47%) had major surgery in the month prior to CDT. Right ventricular systolic pressure and vascular obstruction decreased significantly after CDT. There was a significant decrease in the proportion of patients with right ventricular dilation or hypokinesis. Decrease in pulmonary vascular obstruction was associated with nadir of fibrinogen level. No patients experienced major or moderate bleeding attributed to CDT. CONCLUSION: Catheter-directed thrombolysis is an effective therapy in rapidly alleviating the right heart strain that is associated with increased mortality and long-term morbidity in patients with pulmonary embolism with minimal bleeding risk. Catheter-directed thrombolysis is a safe alternative to systemic thrombolysis in patients with risk factors for bleeding such as prior surgery. Future studies should examine the safety of CDT in patients with contraindications to systemic thrombolysis.