Techniques in Vascular and Interventional Radiology

Pelvic venous disorders are a common and under diagnosed cause of chronic pelvic pain in women, presenting with chronic, noncyclical pelvic pain for greater than 6 months and the presence of pelvic varicosities. Pelvic varices and ovarian vein reflux are a strong indicator of venous origin chronic pelvic and may benefit from embolization. This most commonly occurs in multiparous, premenopausal women with symptoms of gravity dependent pelvic pain and postcoital pain. Additional causes of pelvic venous disorders include iliac vein compression, internal iliac vein reflux, and renal vein compression, however for the purposes of this article we will focus on ovarian vein insufficiency...

Venous stents are being used with increasing frequency, with a multitude of dedicated venous stents now well established or emerging onto the market. This review explores the multifaceted aspects of venous stenting. We discuss the history of venous stents, indications for their use, the imaging required before, during and after stenting, as well as some technical tips and tricks which we have found to be helpful in our own daily practice with a particular focus on iliofemoral venous stenting. Ultimately, this article seeks to enhance the understanding of venous stenting, offering insights into what we feel are best practices, challenges, and prospects for improved patient outcomes...

The full spectrum of venous disease poses a significant burden on individuals and health-care systems globally. Venous disease can lead to a wide range of symptoms based on the level of disease and underlying pathology. In general, underlying pathologies are due to nonthrombotic (reflux/obstructive) and thrombotic causes. Most conditions are a sequela of the long-term effects of chronic venous insufficiency, deep vein thrombosis (DVT), or nonthrombotic deep vein obstruction. The prevalence of venous disease is substantial, impacting the quality of life of a considerable proportion of the adult population...

Pulmonary embolism (PE) in pregnancy accounts for 10% of maternal deaths in the United States. As maternal morbidity and mortality continue to increase, it is imperative for all specialties interfacing with pregnant patients to understand the current research and guidelines surrounding risk stratification, diagnosis, and treatments of PE in pregnancy. Given the complexity of high-risk pregnancy-associated PE (PA-PE), that is, which is associated with hemodynamic instability or collapse, and the rising popularity of new technologies to treat high-risk PA-PE in the nonpregnant population, this review aims to emphasize the differences in diagnosis, risk stratification, and management of the pregnant and nonpregnant PE patients...

Treating cancer patients with deep venous thrombosis/venous thromboembolism (DVT/VTE) can be challenging as patients are frequently unable to receive the standard therapy of anticoagulation due to the increased risk of bleeding complications seen in this population. Similarly, the hesitation of interventionalists to use thrombolytic agents due to bleeding risks limits percutaneous intervention options as well. Further, outcome data and guidelines do not exist for oncologic patients and often treatment is tailored to patient-specific factors after multidisciplinary discussion...

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal condition. Despite existing treatments, recurrence rates and complications remain high. Understanding the pathophysiology of thrombus formation is crucial for developing effective therapies. This narrative review provides an overview of the critical elements of acute and chronic DVT, presents a theoretical framework for understanding thrombus formation, and discusses potential implications for therapeutic interventions...

With an increasing number of interventional and noninterventional treatment options available for venous disorders, it is important that patients undergo a thorough and systematic evaluation. Clinical evaluation should include a personal and family history of venous thromboembolism (VTE), varicose veins, and thrombophilia as these factors affect response and recurrence of disease. Patient should undergo diagnostic and quality of life assessment using validated tools to monitor response to treatment. Duplex ultrasound, both deep and superficial veins, documenting both obstruction and reflux is initial imaging with CT and MRI indicated to document pelvic, iliac vein, and IVC patency and pathology...

This review provides a summary of current practice patterns in managing venous ulcers. The authors will describe the workup for venous ulcers, including differentiation of symptoms, physical examination, and imaging to guide the most effective treatment course for each patient. An overview of conservative management and minimally invasive treatment options for venous ulcers will be provided with a specific focus on periulcer foam sclerotherapy to aid in preventing ulcer recurrence and promoting healing. We will give interventional troubleshooting techniques for challenging patient presentations...

No abstract text is available yet for this article.

As the field of Vascular and Interventional Radiology continues to grow, the variety of pathology treated, the approaches to treating various disease processes, and the vast options of equipment and devices continue to grow as well. Numerous venous disease processes have now become commonplace within the treatment realm of interventional radiologists and knowing how to approach each disease process is critical to successful management of these complex patients. A few of the most encountered venous disease processes include pelvic venous disorders, vena cava tumor involvement, venous thrombosis, and inferior vena cava filter placement; an understanding of the management of these processes is integral to the practice of today's interventional radiologists...

No abstract text is available yet for this article.

Embolization of bone metastases is most commonly performed for hypervascular tumors prior to surgical resection. When employed in this fashion embolization can significantly decrease perioperative hemorrhage and improve surgical outcomes. In addition, embolization of bone metastases may lead to local tumor control and decreased tumoral associate bone pain. Careful techniques and choice of embolic material are required when performing embolization of bone lesions to ensure low procedural complications and high rates of clinical success...

No abstract text is available yet for this article.

Adhesive capsulitis (AC) develops spontaneously without a known cause and is a common cause of painful shoulder. The natural history of AC can last until 36 months and it is classically considered a self-limiting entity, however there is a high rate of refractory cases to conventional treatment with residual deficits during years. There is no consensus on the therapeutic guidelines to be followed in patients with AC. Several authors have pointed out the relevance of hypervascularization of the capsule in the pathophysiology of AC, that is why the objective of transarterial embolization (TAE) is to decrease the abnormal vascularization responsible for the inflammatory-fibrotic state that occurs in AC...

Genicular artery embolization (GAE) is a safe and effective treatment for knee pain related to osteoarthritis, however there are several aspects of the procedure technique which may be unique. Familiarity with procedural steps, arterial anatomy, embolic endpoints, technical challenges, and potential complications is imperative for good clinical practice and outcomes. The success of GAE depends on correctly interpreting angiographic findings and variable anatomy, navigating small and acutely angled arteries, recognizing collateral supply, and avoiding non-target embolization...

In his pioneering work, Okuno and colleagues demonstrated the benefit of musculoskeletal (MSK) embolization, using imipenem as an embolic agent, in various diseases such as knee osteoarthritis (KOA), adhesive capsulitis (AC), tennis elbow and other sports injuries. As imipenem is a last-resort, broad spectrum antibiotic, its use is often not feasible depending on countries and their drug regulation. Since then, several other studies have used other material products such as microparticles or liquid embolics...

The evaluation of a patient with knee osteoarthritis (OA) has 3 main components: clinical history, physical examination, and radiographic imaging. The clinician should assess for inciting and aggravating factors for the knee pain as well as for the presence of any mechanical symptoms. A history of prior knee injury or surgery can suggest the development of early osteoarthritis. A thorough physical examination of the knee should be performed. Some features of OA include limited range of motion, crepitus in the patellofemoral compartment, and joint line tenderness...

In the past decade, angiographic studies have demonstrated neovessels in or in the vicinity of affected joints in many musculoskeletal conditions that used to be considered wear and tear joint disease, such as knee osteoarthritis, frozen shoulder, and overuse injuries. The novelty of this finding is showing the presence of neovascularity at an angiographically detectable level, as compared to histologically evident neovessels that had been discovered years ago. These neovessels have now become the target of interventions in a growing field called muscoskeletal embolotherapy...

Lateral epicondylitis, also known as tennis elbow, is characterized by a low-grade inflammatory process in the lateral aspect of the elbow. Symptoms are typically treated conservatively, and most patients show resolution or improvement of symptoms within a few months. For those with refractory symptoms, treatment options are limited with questionable benefit. Embolization of the arteries supplying the elbow decreases the neo-vascularity seen in epicondylitis. The procedure may result in marked improvement in pain and function, which has shown to be durable...

Osteoarthritis of the knee poses an ever-expanding healthcare challenge worldwide. Current treatments include conservative methods such as weight loss, pharmacological treatments including NSAIDs, and surgical techniques including total knee arthroplasty. Although frequently successful, contraindications and failure of pharmacological agents leave many, especially with mild-moderate disease, without effective treatment. Genicular artery embolization is an interventional radiology technique being developed to fill this treatment gap...