Author spotlight series

Dr. Lakshmi Ratnam discussed her contribution to the special section on women's health, "Uterine artery embolisation: fertility, adenomyosis and size – what is the evidence?"

She discussed how the topic arose from frequent questions on the uterine artery embolization from doctors who perform fewer of these procedures. She highlighted how a lot of myths surrounding the procedure that are debunked when looking at the source evidence, and she hopes that the article will inform practices treating these patients using the evidence available.

By reading this paper, interventionists can gain insights into how to best treat patients using clinical evidence, and helping patients who would like to preserve their fertility and avoid surgery.

Prof. Warren Clements discussed his contribution to the special issue on complications, "Complications in Interventional Radiology: the role of clinical governance and iterative hospital systems in quality improvement".

He discussed how adverse events should trigger healthcare systems to evaluate and make systems-based improvements in care moving forward. He outlined several measures for hospitals to take, such as credentialling and accreditation to meet existing standards as well deal with challenging situations. These should integrate and align within the structure of an organization that has a safety and learning culture.

Dr. Cương spoke to us about his experience with patients with renal lymphatic fistulas and their potential cause, highlighted his the article.

Some patients were treated with stents, and others with embolization - in some cases, they recovered very well and in others, the thoracic duct was occluded and resulted in recurrent chyluria. He also touched on the cause of chyluria, while discussing how the cause of stenosis of the thoracic duct is still unknown.

The insights from this article should help others in the field understand the factors leading to chyluria and offer treatment options to help patients.

Dr. Petra Svarc gave us insights into the case study Prostatic artery embolization in men with severe hemophilia A .

She outlines the development of peri- and postoperative hemostasis plans for two patients with severe hemophilia A set to undergo prostatic artery embolization, for whom there was no protocol in place. The team worked with a hematologist to develop an algorithm to ensure successful embolization.

This case highlights how interventionists can go about developing an algorithm and protocol if they find themselves in a similar situation, and how IRs can adapt to specific patients needs.

Dr. Palm spoke to us about the article he and co-authors wrote. The paper introduces a modified, novel way to custom create a candy-plug device to endovascularly occlude false lumen. The occlusion of backflow to the false lumen can be the reason why the thoracic aorta keeps dilating despite adequate TEVAR placement, meaning this approach to occlude the false lumen could be a gamechanger and offer a versatile method that could be utilized in acute settings.

This could improve patient outcomes and takes endovascular one step further while preserving the option for surgical repair if necessary.

Prof. Carnevale spoke to us about his paper on advanced image guidance for PAE.

PAE is technically demanding due to complex vasculature, anatomical variations and small arteries. This can result in long procedure time, meaning higher radiation dose for staff as well as patients.

By reading this paper, interventionists should be able to gain understanding of the PAE procedure, complications, and techniques through the experience gathered across these four institutions.

Dr. Hernan Bertoni discussed the considerations behind the innovative use of a new stent graft for treatment of complex paravisceral aortic aneurysms in the setting of a chronic dissection. Unique to this design is the ability to perform in situ fenestration for the left renal artery thereby closing the re-entry flap at this level and excluding flow from the false lumen.

This work opens the door to range of treatments for complex anatomy, forging a a new path for treatment of complex thoraco-abdominal aneurysms and other vascular pathologies and offers patients reduced operation time and lower morbidity. Read the full paper here.

Dr. Karim Mostafa spoke to us about the experience gathered in percutaneous DIPS procedures, which offers an alternative to traditional DIPS. The key advantages of performing DIPS percutaneously include not needing expensive endovascular ultrasound machines, in addition to reduced time and higher ease of use.

The paper he and co-authors published in CVIR Endovascular offers a helpful guide to interventionists by outlining the steps of the procedure and giving useful tips and tricks from their experience.

Prof. Hanno Hoppe discussed vascular erectile dysfunction (ED) with us in our most recent video, highlighting how it affects more than 50% of men in their lifetimes, yet many are too embarrassed to discuss it with their doctors. Considering that it can be a marker for other cardiovascular disease, he outlines why it should be taken more seriously and how doctors should address it with patients directly. Luckily, there are endovascular treatments available for ED, and Prof. Hoppe and co-author Nicolas Diehm offer a useful guide for IRs and other practitioners.

Check out the original article as well as the corresponding Letter to the Editorpublished in CVIR Endovascular.

Prof. Keith Quencer spoke to us about the important issue of filter retrieval complications, highlighting why it is crucial to consider them before placing filters at all. The article itself offers a practical user guide with visualisations that outline preconditions for filter retrieval complications.

Check out the original article here for free!

Dr. Kevin Fung discussed the paper "Embolisation of an aneurysmal high-flow renal arteriovenous fistula in a paediatric patient: simultaneous arterial and venous approach."

The simultaneous deployment of coils through artery and veins serves as an alternative to more traditional flow control strategies such as using a proximal occlusion balloon that is more commonly described, especially in paediatric patients who have smaller femoral arteries

Dr. Francesco Giurazza spoke to us about how interventional radiology is characterised by the continuous introduction of new devices and technologies and thus, IRs need to not only be proficient in their clinical practice, but need to also understand the materials they work with. He and co-authors  wrote this paper to explain their experience with the micro vascular plug 

Read the original paper here.

Dr. Mohammed Shamseldin demonstrates how tools and tips from other areas can be applied in interventional radiology. In this video, he describes how cerebral stent retrievers may be used in removing different and rather unusual intra-arterial foreign objects in other parts of the body.

Check out the original paper here!

In the video, Dr. Haraguchi outlines two cases using the novel  "fracking" technique he and co-authors published in the journal. In this technique, deep calcifications are cracked with hydraulic pressure via a balloon indeflator through an 18-gauge needle, which punctures calcifications to achieve greater acute luminal gain.

Check out the original paper for a step-by-step guide for the technique including a video of the procedure!

We were thrilled to have Dr. Pereira talk to us about the paper "Superior hypogastric nerve block (SHNB) for pain control after uterine fibroid embolization (UFE): technique and troubleshooting", which he and co-authors wrote.

He discusses how this procedure offers female patients undergoing uterine fibroid embolisation pain control without opioids, and can even mean same-day discharge, which is a game changer for patients as well as doctors performing these procedures.

We caught up with Prof. Colin Cantwell, who discussed "Conventional angiography findings in hemodynamically unstable patients with acute abdominal hemorrhage and a negative CT bleeding study", the paper he and co-authors wrote on conventional angiography findings in hemodynamically unstable patients with acute abdominal hemorrhage with a preceding negative CTA. They analysed data to see if there is a connection between bleeding site and false CT findings.

Prof. Quencer has published several of the journal's most accessed papers, and we were delighted to have him talk to us about the paper "Adrenal vein sampling: technique and protocol, a systematic review" where he gave an overview of this procedure, including an assessment of different techniques and protocols in order to offer a guide to readers and to increase the procedure success rate overall.

Our most recent video features Prof. Kensaku Mori, who describes the "pigtail through snare" technique he and co-authors developed to capture a catheter fragment. This technique is easier than the traditional 2-step technique, and is faster, thus reducing procedure time and radiation exposure.

This video features Dr. Anne Gill, who discusses the paper she and co-author Giridhar M. Shivaram contributed to the CVIR Endovascular special section on paediatric IR. She outlines her experience and offers suggestions for medication, equipment, workup, and identifies barriers to successful management of acute and chronic systemic venous occlusions in children.

This video features Dr. Osman Ahmed, who presents the paper "Transsplenic portal vein recanalization and direct intrahepatic portosystemic shunt placement to optimize liver transplantation."

He discussed a case where a patient with existing complications (incl. hepatic vein occlusion) needed to undergo a liver transplant, and how the team took a unique approach, utilising a trans-splenic PVR with DIPS placement. He emphasised the collaborative nature of this case and how this knowledge can be used to help other patients in the future.

Dr. Monica Matsumoto discusses the paper that she and co-authors wrote, "Hybrid CT-angiography to facilitate lower extremity sharp venous recanalization: a novel approach to a common procedure."

In the video, she outlines how the case at hand highlights the potential for endovascular treatment (in this case, hybrid CT-Angiography, more commonly used in interventional oncology) of chronic venous occlusions.

This video features Prof. Warren Clements, who discusses the paper he and co-authors wrote about the SPLEEN-IN study: SPLEnic salvage and complications after splenic artery EmbolizatioN for blunt abdomINal trauma.

He gives insight into how splenic artery embolisation offers many blunt trauma patients an alternative to splenectomy, and explains why it is important to keep your spleen! 

The series kicks off with Dr. Gregory Makris, who discusses the Letter to the Editor that he and co-authors published on unnecessary hysterectomies and the role of the interventional radiology community.