Optimizing care for the obese patient in interventional radiology

Aberle, Dwight; Charles, H.; Hodak, Steven P.; O'Neill, D; Öklü, Rahmi; Deipolyi, Amy R.

doi:10.5152/dir.2016.16230

Cited by 10 publications

(11 citation statements)

References 61 publications

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“…Generally, it is also possible to drain an abdominal collection under ultrasound guidance. However, of all available imaging modalities, ultrasound is most frequently limited by body habitus [20,31]. To the best of our knowledge, there are no studies evaluating abdominal ultrasound-guided drain implantation in very obese patients or after bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

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CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures

Schwarz

Strobl

Paprottka

et al. 2019

Fortschr Röntgenstr

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Purpose To observe the technical and clinical outcome as well as safety of CT fluoroscopy-guided drain placement in the multimodal clinical complication management of superinfected gastric leakage after sleeve gastrectomy. Materials and Methods All consecutive patients who underwent CT fluoroscopy-guided drain placement to treat superinfected postoperative leakage after sleeve gastrectomy in our department between 2007 and 2014 were included in this retrospective study. All interventions were performed on a 16- or 128-row CT scanner under intermittent CT fluoroscopy guidance (15–25 mAs, 120 kV). The technical and clinical success rates as well as complications, additional therapies and patient radiation dose were analyzed. Results 14 patients (mean age: 43.8 ± 11.3 years, mean BMI: 52.9 ± 13.5, 7 women) who underwent a total of 31 CT fluoroscopy-guided drain placement procedures were included. 30 of 31 interventions (96.8 %) were technically successful. 7 patients underwent more than one intervention due to drain obstruction or secondary dislocation or as further treatment. During and after the intervention no procedure-associated complications occurred. In all patients, inflammation parameters decreased within days after the CT-guided intervention. The total interventional dose length product (DLP) was 1561 ± 1035 mGy*cm. Conclusion CT fluoroscopy-guided drain placement has been shown to be a safe minimally invasive procedure that rarely leads to complications for treating superinfected gastric leakage occurring after sleeve gastrectomy. We assume that operative revisions in a high-risk patient group can be avoided using this procedure. Key Points: Citation Format

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Section: Discussionmentioning

confidence: 99%

“…Additional equipment for transportation, monitoring and nursing is needed. Comorbidities like hypertension, sleep apnea and diabetes need to be observed [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures

Schwarz

Strobl

Paprottka

et al. 2019

Fortschr Röntgenstr

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“…Performing image-guided interventional procedures in obese patients can present its own technical challenges independent of the imaging portion of the interventions. 2,28,29 These challenges include adequately visualizing targeted areas, inadequate instrument/equipment length, ability of the instruments and large patient to fit into CT and MRI scanners, radiation doses in interventional radiology procedures, safely sedating obese patients, post-procedure recovery and healing.…”

Section: Image-guided Interventionsmentioning

confidence: 99%

“…Multiple studies have evaluated the limitations of performing ultrasound procedures in obese patients. [29][30][31] Poor sonographic visualization can potentially lead to non-diagnostic specimens and higher rates of complications. 29 Solutions to address this include performing transjugular non focal kidney 30 or liver biopsy instead of percutaneous biopsies or positional changes such as placing patients for non-focal renal biopsies in a supine position and approaching the kidney from an anterolateral approach 31 Instrument length All wires and catheters used for interventional procedures are manufactured at standard lengths.…”

Section: Adequately Visualizing Targetsmentioning

confidence: 99%

Technical challenges of imaging & image-guided interventions in obese patients

Uppot

2018

BJR

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Obese patients challenge imaging departments in their ability to obtain diagnostic quality images and to perform image-guided interventions. These technical challenges include properly accommodating large patients on imaging equipment, adjusting equipment settings to address imaging limitations, and pre-planning and preparation for image-guided interventions to insure safe and successful outcomes. Knowing and addressing these challenges can result in successfully addressing the imaging and image-guided interventions needs of obese patients.

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“…Thick tissue can also limit compression and increase the likelihood of access-site bleeding. 81,82 Obese patients are also at a higher risk for various complications resulting from these procedures. [82][83][84][85] The issues surrounding endovascular treatment of obese patients can be minimized with close management, and relationships with consulting services.…”

Section: Conventional Lower Extremity Venography and Pulmonary Angiogmentioning

confidence: 99%

Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients

Cascio

Hon

Haramati

et al. 2018

BJR

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Obesity is a growing problem around the world, and radiology departments frequently encounter difficulties related to large patient size. Diagnosis and management of suspected venous thromboembolism, in particular deep venous thrombosis (DVT) and pulmonary embolism (PE), are challenging even in some lean patients, and can become even more complicated in the setting of obesity. Many obstacles must be overcome to obtain imaging examinations in obese patients with suspected PE and/or DVT, and to ensure that these examinations are of sufficient quality to diagnose or exclude thromboembolic disease, or to establish an alternative diagnosis. Equipment limitations and technical issues both need to be acknowledged and addressed. Table weight limits and scanner sizes that readily accommodate obese and even morbidly obese patients are not in place at many clinical sites. There are also issues with image quality, which can be substantially compromised. We discuss current understanding of the effects of patient size on imaging in general and, more specifically, on the imaging modalities used for the diagnosis and treatment of DVT and PE. Emphasis will be placed on the technical parameters and protocol nuances, including contrast dosing, which are necessary to refine and optimize images for the diagnosis of DVT and PE in obese patients, while remaining cognizant of radiation exposure. More research is necessary to develop consistent high-level evidence regarding protocols to guide radiologists, and to help them effectively utilize emerging technology.

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Optimizing care for the obese patient in interventional radiology

Cited by 10 publications

References 61 publications

CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures

CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures

Technical challenges of imaging & image-guided interventions in obese patients

Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients

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