Sinistral or left-sided portal hypertension is a localized form of portal hypertension usually due to isolated obstruction of splenic vein. Most commonly, it is secondary to pancreatitis. Rarely this can present as life-threatening gastric variceal bleeding. In such patients, splenectomy is traditionally considered as the treatment of choice to relieve venous hypertension. Unfortunately, a surgical operation may not be safe in most of the patients because of the unfavorable operative field. Splenic artery embolization (SAE) is an effective method, theoretically akin to splenectomy, blocking the direct arterial inflow to the spleen and thereby reducing the outflow venous pressure. The authors demonstrate a case of a 58-year-old man who presented with severe gastric variceal hemorrhage due to sinistral portal hypertension (SPH) secondary to an episode of pancreatitis, which he had 1 month back. He was successfully managed by SAE and remains symptom-free. The authors bring to the fore the potential curability of gastric variceal hemorrhage secondary to SPH using SAE, which is a safe and effective interventional radiologic procedure.
Venous insufficiency of the lower limb is a common condition characterized by a spectrum of symptoms, including bulging leg veins, pain, swelling, and ulceration. Various treatment options are available; however, the newer endovascular options are easy, highly effective, safe, and quick in relieving symptoms. Endovascular treatment options include thermal ablation, mechanicochemical ablation, and foam sclerotherapy. This review article briefly describes various scoring systems used in varicose veins, the role of imaging, different management techniques, and guidelines proposed in the management of this condition. AbstractKeywords ► varicose vein ► intervention ► radiology
Addition of US unit to the angiographic suite is effortless and Interventional Radiologists being already skilled in US can easily implement this simple yet valuable modification to conventional TJLB procedures. Our experience on uTJLB further emphasizes the role of US guidance in improving the procedural success rate, safety profile, and efficacy in the histopathological outcome of TJLB in all patients irrespective of age and disease burden.
INTRODUCTIONPancreatic carcinoma accounts for a significant propotion of cancer related death toll in developing countries like India. Increase in the incidence has been linked to risk factors like lifestyle modification associated with increased alcohol consumption and rapid urbanisation [1]. Dhir V reported an incidence of 0.5-2.4 per 1,00,000 men and 0.2-1.8 per 1,00,000 women in India, with higher rates seen in the male urban populations of western and northern India [2]. Balakrishnan V et al., recently conducted a multicentre study to assess chronic pancreatitis in 1086 subjects which showed an incidence rate of about 4% for pancreatic tumours [3]. Only 16% of patients initially present with a disease completely confined to the pancreas [4,5], with about 85%-90% having surgically unresectable tumours at the time of diagnosis [4][5][6]. Surgical resection offers the only chance for cure and imaging plays a crucial role in the early diagnosis of the condition; the various imaging modality currently used in the diagnosis and preoperative staging of carcinoma pancreas includes; Ultrasonography (USG), contrast-enhanced Computed Tomography (CT), Magnetic Resonance Imaging (MRI), magnetic resonance cholangiopancreatography and endoscopic ultrasound. Contrast enhanced computed tomography is the imaging modality of choice for diagnosis and preoperative staging of the condition.Preoperatively pancreatic carcinoma can be categorized into resectable, unresectable and borderline resectable tumours. Bipat S et al., in a meta-analysis, found a sensitivity of 81% and specificity of 82%, for determining resectability [7]. Borderline resectable tumours has been defined by National Comprehensive Cancer Network as tumours that display: (a) venous involvement of the superior mesenteric vein-portal vein confluence with possibility of vascular reconstruction; (b) encasement of gastroduodenal artery up to hepatic artery or hepatic artery involvement with no celiac extension; or (c) tumour abutting superior mesenteric artery less than 180 0 [8]. MRI has shown results like CT and is reserved for those patients on whom CT cannot be performed. Newer sequences such as diffusion weighted imaging has shown fruitful results in the evaluation of pancreatic lesion using quantitative analysis by calculating mean ADC values [9].CT and MRI are excellent modalities in assessment of perineural invasion associated with pancreatic carcinoma. On CT perineural invasion should be suspected when: (1) On MRI perineural involvement is graded on assessing the regions posterior and medial to the pancreatic head, posterior to body of the pancreas and the involvement of major vessels adjacent to the tumour, including the SMV and/or portal vein, SMA, celiac axis artery, common and/or proper hepatic artery, and splenic artery as; NV0-signal intensity of fat adjacent to the lesion shows no change, NV1-signal intensity suggestive of fat standing, NV2-mass larger than 1 cm adjacent to the lesion [10].The purpose of this study was to assess the accuracy of multi...
A checklist can be defined as a comprehensive formal list of essential actions to be taken in a specific fashion. This concept has been extended from the aviation industry to health care to improve patient outcome and patient satisfaction with a significant reduction in complication rates. This review article aims to assess the importance and benefits associated with the use of a well-formulated checklist while performing the various minimally invasive image-guided procedures. Various databases including PubMed, Medline, Scopus, and Cochrane were searched for using various keywords including “Checklist,” “Radiology,” “Interventional Radiology,” “Image-Guided Procedure,” and “minimally invasive procedure.” The use of a checklist is the way ahead especially when patients today require minimal risk but demand high-quality care. Implementation of such an easy-to-perform tailor-made mechanism can significantly improve patient outcome and patient satisfaction.
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