The glycoprotein IIb/IIIa (GP IIb/IIIa) antagonists are the most recent additions to the antiplatelet agents available to the interventional radiologist. The currently available GP IIb/IIIa antagonists are abciximab, eptifibatide, and tirofiban. These medications have demonstrated excellent safety and efficacy in the setting of coronary arterial interventions. The fundamental benefit of the GP IIb/IIIa antagonists lies in their unique mechanism of action: the ability to prevent platelet aggregation, thrombus formation, and distal thromboembolism while preserving initial platelet binding to damaged vascular surfaces. A paucity of data exists regarding the role of GP IIb/IIIa inhibitors in peripheral vascular interventions. The GP IIb/IIIa antagonists would theoretically provide excellent antiplatelet therapy in patients undergoing any of a variety of endovascular interventions during which thrombosis or thromboembolism may endanger distal perfusion in patients with peripheral vascular disease. The goal of this summary is to review the indications for use, pharmacology, and evidence for efficacy of the GP IIb/IIIa antagonists in hopes of translating these data for application in the peripheral arterial circulation. Further research is necessary to determine how these agents may be safely used in combination with other anticoagulants or with stents, efficacy compared with standard regimens, success at preventing distal thromboembolism, and cost effectiveness. Semin Intervent Radiol 2010;27:412–421. Copyright © 2010 by Thieme Medical Publishers, Inc. ISSN 0739-9529.
To perform safe invasive procedures on patients on anticoagulation therapy, management of the patient’s anticoagulation status is mandatory. For patients on anticoagulation therapy, a risk analysis of both the procedural risk of bleeding as well as the risk to the patient from discontinuing anticoagulation needs to be performed. For procedures at low risk of bleeding, the procedure may be performed with little change to the patient’s anticoagulation regimen. For procedures with significant bleeding risk, however, anticoagulation will need to be held or reversed. Patients at high risk for thromboembolic complications will require bridging therapy if anticoagulation is to be withheld. In this article, a logical assessment of bleeding risk in patients undergoing procedures is presented, and a review of anticoagulation and risk is discussed. Semin Intervent Radiol 2010;27:360–367. Copyright © 2010 by Thieme Medical Publishers, Inc. ISSN 0739-9529.
Due to medical illness or pharmacotherapy, patients undergoing percutaneous interventions often have abnormal hemostasis. Its etiology may include alterations in the protein-based coagulation system, thrombocytopenia, deficient platelet function, or mixed deficits such as disseminated intravascular coagulation. In this article, the authors review the basic science of each of these etiologies, as well as their available methods of correction. They also review the evidence and guidelines regarding the assessment and treatment of coagulopathy in image-guided procedures. The periprocedural bleeding risk and the urgency of a given procedure guide the management of abnormal hemostasis in this patient population. Semin Intervent Radiol 2010;27:338–347. Copyright © 2010 by Thieme Medical Publishers, Inc. ISSN 0739-9529.
Sclerotherapy is the therapeutic use of sclerosants in the controlled destruction of undesired target tissues. Sclerosants have been used in vascular and nonvascular settings, both as primary and adjunctive therapy. Effective sclerotherapy requires a conceptual understanding of key questions about the process being treated, including the method of delivery, the presence of flow, and the required contact time to initiate sclerosis. However, beyond technique and delivery, practical and safe application of sclerotherapy requires an understanding of the uses, limitations, dosing, and side effects of sclerosants used during interventional radiology procedures. Agents discussed here include detergents and surfactants [ethanol, Sotradecol 1 (Bioniche Pharma, Pointe Claire, Quebec and Angiodynamics, Latham, NY), ethanolamine oleate], hypertonics (saline, glucose), and a review of several other types that are used less frequently. Semin Intervent Radiol 2010;27:391–399. Copyright © 2010 by Thieme Medical Publishers, Inc. ISSN 0739-9529.
In this article, the authors review the basic principles of cancer chemotherapy and provide an overview of each of the general classes of chemotherapeutic agents with a target audience of interventional radiologists in mind. Special attention is paid to agents used in regional chemotherapy as well as agents commonly included in systemic chemotherapeutic regimens for patients who also require regional chemotherapy. Semin Intervent Radiol 2010;27:384–390. Copyright © 2010 by Thieme Medical Publishers, Inc. ISSN 0739-9529.
Modern interventional radiology practice is continuously evolving. Developments include increases in the number of central venous catheter placements and tumor treatments (uterine fibroid therapy, radio- and chemoembolization of liver tumor, percutaneous radiofrequency and cryoablation), and new procedures such as abdominal aortic aneurysm stent-graft repair, vertebroplasty, kyphoplasty, and varicose vein therapies. There have also been recent advancements in standard biliary and urinary drainage procedures, percutaneous gastrointestinal feeding tube placement, and transjugular intrahepatic portosystemic shunts. Prophylactic antibiotics have become the standard of care in many departments, with little clinical data to support its wide acceptance. The rise in antibiotic-resistant strains of organisms in all hospitals worldwide have forced every department to question the use of prophylactic antibiotics. The authors review the evidence behind use of prophylactic antibiotics in standard interventional radiology procedures, as well as in newer procedures that have only recently been incorporated into interventional radiology practice. Semin Intervent Radiol 2010;27:327–337. Copyright © 2010 by Thieme Medical Publishers, Inc. ISSN 0739-9529.
Purpose: To prospectively evaluate outcomes associated with use of a triple-lumen (TL) peripherally inserted central catheter (PICC) in the intensive care unit (ICU) setting. July 2010 Radiology: 256, 312-320. Copiryght © RSNA, 2010
Inferior vena cava filters are commonly used in patients with contraindications to or failures of treatment with anticoagulation. However, these are not without complications. Serious complications include penetration of the filter struts into adjacent structures, including the aorta. The design of permanent filters makes retrieval in the instance of life-threatening complication complex, often requiring extensive surgical exploration. Retrievable filters may be more easily removed via endovascular methods, reducing the morbidity of surgical approaches. Vascular and Endovascular Surgery 44(8) 683-686. Copyright The Author(s) 2010
Purpose: To determine comprehensive imaging and long-term survival outcome following chemoembolization for hepatocellular carcinoma (HCC). June 2010 Radiology: 255, 955-965. Copyright © RSNA, 2010
Purpose: To classify peripheral pulmonary arterial pseudoaneurysms (PAPs) associated with infectious lung diseases according to angiographic findings and to determine treatment options for PAPs on the basis of angiographic classifications. August 2010 Radiology: 256, 656-664. Copiryght © RSNA, 2010
Purpose: To determine the clinical importance of the bird-beak configuration after thoracic endovascular aortic repair (TEVAR). May 2010 Radiology: 255, 645-652. Copiryght © RSNA, 2010
Purpose: To retrospectively evaluate the clinical outcome of patients with hepatocellular carcinoma (HCC) who exceeded the Milan criteria, who underwent transarterial chemoembolization (TACE) before orthotopic liver transplantation (OLT), to determine the value of computed tomography (CT)-based tumor response to TACE as a preoperative selection criterion for OLT. April 2010 Radiology: 255, 289-300. Copiryght © RSNA, 2010
Reperfusion therapy using thrombolytic agents has been shown to be a safe and effective treatment strategy for arterial ischemia, venous thrombosis, massive pulmonary embolism, and acute stroke. Thrombolytic agents have evolved over the course of a few decades, from nonfibrin selective to fibrin-selective agents. The development and modification of these agents have resulted in improved understanding of their pharmacologic attributes, and their effects on the complex molecular events that occur during thrombolysis goal-directed therapies. The current review focuses on the physiology and pharmacology of the thrombolytic agents that have been or are currently in use for interventional thrombolysis interventions. Attention is also given to the particular role that thrombolytic agents play in the current management of peripheral vascular disease and acute stroke. Semin Intervent Radiol 2010;27:374–383. Copyright © 2010 by Thieme Medical Publishers, Inc. ISSN 0739-9529.
Purpose: To evaluate the clinical effectiveness of transcatheter arterial chemoembolization (TACE) performed in patients with nonresectable combined hepatocellular carcinoma (HCC) and cholangiocarcinoma and analyze the prognostic factors of patient survival after TACE. April 2010 Radiology: 255, 270-277. Copiryght © RSNA, 2010
Purpose: To analyze the characteristics associated with membranous obstruction of the inferior vena cava (MOVC)–associated hepatocellular carcinoma (HCC) and to evaluate the clinical efficacy of transcatheter arterial chemoembolization (TACE). February 2010 Radiology: 254, 617-626. Copiryght © RSNA, 2010
Cookies Sociales
Son esos botones que permiten compartir el contenido del sitio web en sus redes sociales (Facebook, Twitter y Linkedin, previo tu consentimiento y login) a través de sistemas totalmente gestionados por dichas redes sociales, así como los recursos (pej. videos) y material que se encuentra en nuestra web, y que de igual manera se presta y gestiona completamente por un tercero.
Si no acepta estas cookies, no podrá compartir nuestro contenido a través de los botones, y en su caso, no podrás visualizar el contenido de terceros que hayamos incrustado en el sitio.
No las utilizamos