Breast density is now established as an independent risk factor for developing breast cancer irrespective of other known risk factors. Women with breast density in the upper quartile have an associated four to five times greater risk of developing breast cancer relative to women with breast density in the lower quartile. Many states have enacted or proposed legislation requiring mammographers to report to patients directly if they have dense breast tissue and recommend discussing the possibility of a supplemental screening examination with their physicians. However, there is currently no consensus as to whether a supplemental screening examination should be pursued or which modality to use. Possible supplemental screening modalities include ultrasound, MRI, digital breast tomosynthesis, and molecular breast imaging. The U.S. Food and Drug Administration recently approved an automated breast ultrasound system for screening whole-breast ultrasound in patients with dense breasts. However, many questions are still unanswered including the impact on morbidity and mortality, cost-effectiveness, and insurance coverage.
Although there is no consensus for the management of endovascular stents that have migrated to the pulmonary arteries, stent retrieval may be necessary in cases where arterial flow is compromised or heavy clot burden is a concern. Moreover, steps toward prevention of stent fracture and migration should be considered in order to preclude such occurrences--avoidance of puncturing the stent for hemodialysis access, discontinuation of use of the Arrow-Trerotola device through or near stents, and consideration of short segment angioplasty for regional intrastent stenosis rather than typical long segment venous angioplasty.
Percutaneous drainage catheter placement is a frequently performed interventional radiology procedure. One of the common management complications of such catheters is obstruction or clogging of the catheter. Occluded drainage catheters are routinely exchanged over a guidewire under fluoroscopic guidance. At times, however, a guidewire cannot be passed through the catheter obstruction, and exchanging the catheter over a guidewire may become difficult or even impossible without losing access. Because salvaging an obstructed catheter, without risking loss of access, can be difficult, multiple techniques to preserve organ access have been developed. This chapter describes a technique whereby the creation of a new side hole in the catheter is used to re-establish wire access and facilitate catheter exchange. It is frequently useful for exchanging enteric tubes, urologic drainage catheters, biliary drainage catheters, and abscess drains.
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