Percutaneous nephrostomy placement in pregnant patients: a retrospective single center experience.

PURPOSE: Literature on percutaneous nephrostomy (PCN) placement in pregnant patients is limited. The purpose of this case series of 20 pregnant patients was to report short term maternal and fetal outcomes in this population. MATERIALS AND METHODS: A 12-year retrospective study was performed on pregnant patients undergoing PCN. Clinical indications, technical success, maternal outcome, fetal outcome, and complications were obtained from the electronic medical record. RESULTS: Indications for PCN placement included urolithiasis (40%), congenital ureteral dysfunction in the setting of prior ureteral repair (30%), obstruction associated pain (15%), infection (10%), and ureteral injury in the setting of surgery for ovarian torsion (5%). Catheter insertion was successful in all patients (n = 20), with one major complication (urosepsis). Follow up data was available in 19 patients (95%). Catheters were in situ for a median of 82 days. All patients had clinical and symptomatic improvement. Emergency C-sections were required in two cases. Radiation exposure data were available in 15 of 19 patients and revealed a median fluoroscopy time of 2.8 min, median cumulative dose of 43 mGy, and median dose area product of 635 µGy × m2. No adverse fetal outcomes were recorded at time of delivery. CONCLUSION: PCN placement has good clinical results as a treatment option for ureteral obstruction in a pregnant cohort.

JOURNAL CLUB: Women in Interventional Radiology: How Are We Doing?

OBJECTIVE: This article describes survey findings as well as provides a narrative description of the issues facing women in interventional radiology (IR) today. MATERIALS AND METHODS: In an attempt to reflect the experiences of as many women interventional radiologists as possible, a survey was conducted via a post on the Women in Interventional Radiology page of SIR Connect, the online members-only forum of the Society of Interventional Radiology (SIR). The survey consisted of 62 items, including demographics, marital and parental status, experiences in training, relationships with coworkers and patients, and details about career achievements and goals. Respondents were encouraged to write comments. We analyzed responses for trends and reviewed comments. RESULTS: Ninety-nine surveys were completed. Women at all phases of training and practice and in a broad range of practice settings were represented. Many women responding to the survey reported experiences with gender bias, discrimination, and sexual harassment. CONCLUSION: Further research is needed to better understand gender bias in IR and how it affects women throughout their training and careers. From this research, evidence-based interventions can be implemented to help level the playing field for all. Women are committed to and passionate about IR, and IR needs women to succeed so that the field can continue to thrive.

Thoracic duct embolization and disruption for treatment of chylous effusions: experience with 105 patients.

PURPOSE: To review the indications, technical approach, and clinical outcomes of thoracic duct embolization (TDE) and thoracic duct disruption (TDD) in patients with symptomatic chylous effusions. MATERIALS AND METHODS: A total of 105 patients who underwent 120 consecutive TDE/TDD procedures were retrospectively reviewed. Data including cause of effusion, procedural technique, and pre- and postprocedural effusion volume were analyzed. Technical and clinical success were evaluated for each procedure, with technical success defined as successful interruption of the thoracic duct by embolization or needle disruption and clinical success defined as resolution of effusion without surgical intervention. RESULTS: The technical success rate was 79% (95 of 120); 53 TDEs were performed, resulting in a 72% clinical success rate (n = 38), whereas 42 TDDs showed a 55% clinical success rate (n = 23; P = .13). Procedures to treat postpneumonectomy chylous effusions had a success rate of 82% (14 of 17), compared with 47% (nine of 19) in postpleurectomy subjects (P < .05). Clinically successful cases had lower 24-, 48-, and 72-hour postprocedural effusion volumes versus clinically unsuccessful cases (P < .05), as well as greater rates of reduction in effusion volume at these time points (P < .05). Clinical success rate in subjects with traumatic effusions was higher than in subjects with nontraumatic effusions (62% [60 of 97] vs 13% [one of eight]; P < .05), and 6.7% of subjects (n = 7) experienced minor complications. CONCLUSIONS: TDE and TDD are safe and effective minimally invasive treatments for traumatic thoracic duct injuries. In the present series, factors affecting procedural success included etiology of effusion, postprocedural effusion volume, and rate of postprocedural effusion volume reduction.

Acute Pericardial Effusion during Endovascular Intervention for Superior Vena Cava Syndrome: Case Series and Review.

We describe three cases of acute pericardial effusion during endovascular treatment of superior vena cava (SVC) syndrome, one of which resulted in fatal pericardial tamponade. SVC syndrome results from impaired venous return from the head and upper extremities to the right atrium. Malignancy and catheter-induced SVC stenosis accounts for the majority of cases of SVC syndrome. Endovascular therapy is the treatment of choice for SVC syndrome due to its rapid relief of symptoms and low morbidity. Acute pericardial effusion and pericardial tamponade may result from inadvertent extraluminal traversal of the SVC in the so-called danger zone above the right atrium, as well as secondary to dissection of wires in a location where fascial planes have been altered by neoplasia or inflammation.

Uterine artery embolization and hysteroscopic resection to treat retained placenta accreta: A case report.

Retained placenta is a serious cause of postpartum hemorrhage. Compounding this problem is the rare finding of a retained placenta accreta. Different authors have presented management options for retained placenta accreta that include methotrexate, uterine artery embolization, dilation and curettage, hysteroscopic loop resection, and hysterectomy. We report here on a patient who was diagnosed with a retained placenta accreta and underwent successful conservative treatment with uterine artery embolization followed by hysteroscopic morcellation. Whereas other methods have failed due to bleeding and/or infection, this case illustrates a potential new means of addressing this challenging obstetrical complication.