Advanced Interventional Procedures for Knee Osteoarthritis: What Is the Current Evidence?

The prevalence of knee osteoarthritis (OA) is the highest among all joints and likely to increase over the coming decades. Advances in the repertoire of diagnostic capabilities of imaging and an expansion in the availability and range of image-guided interventions has led to development of more advanced interventional procedures targeting pain related to OA pain while improving the function of patients presenting with this debilitating condition. We review the spectrum of established advanced interventional procedures for knee OA, describe the techniques used to perform these procedures safely, and discuss the clinical evidence supporting each of them.

Role of interventional radiology in the treatment of COVID-19 patients: Early experience from an epicenter.

OBJECTIVE: To highlight the role of interventional radiology (IR) in the treatment of patients hospitalized with coronavirus disease 2019 (COVID-19). METHODS: Retrospective review of hospitalized patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and had one or more IR procedures at a tertiary referral hospital in New York City during a 6-week period in April and May of 2020. RESULTS: Of the 724 patients admitted with COVID-19, 92 (12.7%) underwent 124 interventional radiology procedures (79.8% in IR suite, 20.2% at bedside). The median age of IR patients was 63 years (range 24-86 years); 39.1% were female; 35.9% in the intensive care unit. The most commonly performed IR procedures were central venous catheter placement (31.5%), inferior vena cava filter placement (9.7%), angiography/embolization (4.8%), gastrostomy tube placement (9.7%), image-guided biopsy (10.5%), abscess drainage (9.7%), and cholecystostomy tube placement (6.5%). Thoracentesis/chest tube placement and nephrostomy tube placement were also performed as well as catheter-directed thrombolysis of massive pulmonary embolism and thrombectomy of deep vein thrombosis. General anesthesia (10.5%), monitored anesthesia care (18.5%), moderate sedation (29.8%), or local anesthetic (41.1%) was utilized. There were 3 (2.4%) minor complications (SIR adverse event class B), 1 (0.8%) major complication (class C), and no procedure-related death. With a median follow-up of 4.3 months, 1.1% of patients remain hospitalized, 16.3% died, and 82.6% were discharged. CONCLUSION: Interventional radiology participated in the care of hospitalized COVID-19 patients by performing a wide variety of necessary procedures.

Role of interventional radiology in the management of hepatocellular carcinoma: current status.

The treatment of patients with hepatocellular carcinoma requires a careful balance of adequate oncologic control and the preservation of both liver function and performance status. Over the last few decades, the emerging field of interventional oncology has introduced a variety of minimally invasive, safe and effective therapies, expanding the armament of available treatment options. The Barcelona Clinic Liver Cancer staging system is the most widely adopted treatment classification which aims to match patients with the therapies that will yield the best outcomes based on these factors. Radiofrequency ablation has been recommended by this system for patients with very early stage disease and trans-arterial chemoembolization has been recommended as the gold standard therapy for patients with intermediate grade disease. Technical innovation brings newer ablative and embolotherapy techniques into practice, while clinical innovation continues to expand the indications of these treatments outside of the formal paradigm. This article will provide an overview of the varied interventional procedures being used in clinical practice and will review how they can be used to cure very early and early stage disease, to facilitate surgical resection, to bridge or downstage tumors for liver transplantation, and extend survival as palliative interventions in patients with intermediate or advanced disease.

Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain.

Chronic upper abdominal pain occurs as a complication of various malignant and benign diseases including pancreatic cancer and chronic pancreatitis, and when present may contribute to lower quality of life and higher mortality. Though various pain management strategies are available as part of a multimodal approach, they are often incompletely effective and accompanied by side effects. Pain originating in upper abdominal viscera is transmitted through the celiac plexus, which is an autonomic plexus located in the retroperitoneum at the root of the celiac trunk. Direct intervention at the level of the plexus, referred to as celiac plexus block or neurolysis depending on the injectate, is a minimally invasive therapeutic strategy which has been demonstrated to decrease pain, improve function, and reduce opiate dependence. Various percutaneous techniques have been reported, but, with appropriate preprocedural planning, use of image guidance (usually computed tomography), and postprocedural care, the frequency and severity of complications is low and the success rate high regardless of approach. The main benefit of the intervention may be in reduced opiate dependence and opiate-associated side effects, which in turn improves quality of life. Celiac plexus block and neurolysis are safe and effective treatments for chronic upper abdominal pain and should be considered early in patients experiencing such symptoms.