Need more help in the IR suite?

If you feel like you need more ancillary support in the IR suite, but haven’t been able to convince your administrators, you’re in luck. The Society of Interventional Radiology (SIR) Standards Division Committee has just published the results of their survey on the status and physician opinion regarding ancillary staffing for the IR suite. After receiving responses from over 700 physicians, the workgroup found that staffing is not deficient based on American College of Radiology (ACR) guidelines. However, physicians remain dissatisfied. This may be due to the ACR guidelines lacking consideration of procedure complexity or the availability of scrubbed assistants. During weekends or off-hours, staffing and access to anesthesia support were felt to be inadequate by the respondents.

This important survey serves as the first step in creating evidence-based guidelines on IR suite staffing. Until additional investigations can be completed, this report can be used as an important tool for physicians negotiating for more staff.


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Numbers of procedure rooms in the operator’s primary setting.




Circumstances under which anesthesia service support is routinely used at the respondent’s institution.


Citation: Natcheva, H. N. et al. Survey of Current Status and Physician Opinion Regarding Ancillary Staffing for the IR Suite. Journal of Vascular and Interventional Radiology 25, 1777–1784 (2014).


Post author: Amish Patel, MD

Complications associated with strut penetration in Celect filter

Strut penetration associated with Celect filter placement is a known entity. Researchers from the University of Chicago retrospectively evaluated patients who had an abdominal CT performed following Celect filter placement. The present study demonstrated strut penetration rate of 28.5% that was positively associated with indwelling time longer than 100 days. Strut penetration was defined as a filter leg extending >3mm beyond the IVC wall. Despite strut penetration, researchers saw no evidence of associated breakthrough PE or retrieval failure.

Comments:

The analysis of the presence and effects of strut penetration is limited in this study as only a subset of filter recipients had an abdominal CT performed and the true clinical impact of strut penetration was not evaluated. However, the paper is noteworthy demonstrating no association between rate of strut penetration and breakthrough PE, local complication, or retrieval failure.


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Strut penetration in a 44-year-old female patient with back pain. (a) Image from a contrast-enhanced CT shows right hydronephrosis. (b) A more caudal image from the same CT examination demonstrates strut compression of the proximal right ureter (arrow). The filter was successfully removed, and a suprarenal filter was placed. 

Citation: Bos, A. et al. Strut Penetration: Local Complications, Breakthrough Pulmonary Embolism, and Retrieval Failure in Patients with Celect Vena Cava Filters. Journal of Vascular and Interventional Radiology (2014). doi:10.1016/j.jvir.2014.09.010


Post Author: Luke Wilkins, MD

Pedal Access for Revascularization of Infrainguinal Occlusive Disease

While treatment of endovascular revascularization in CLI is an effective method to achieve limb salvage, technical success and amputation-free survival vary widely. However, in a patient that fails antegrade recanalization in whom bypass options are nonextistent, a retrograde approach from a pedal access may be a viable option. Researchers from the University of Virginia presented their experience with pedal access in 99 limbs. Technical success was achieved in 89% of patients with a majority involving subinitimal recanalization. The limb salvage rate for technically successful cases was 74% at 6 months, 64% at 12 months, and 55% at 24 months.

Comments:

This study is one of the largest series of pedal access cases and shows a high technical success rate in a challenging patient population. While limb salvage rates are not ideal, the study was limited by premature amputations and revascularization to achieve tissue healing for a pre-planned amputation.


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(a) Digital subtraction angiography shows occlusion of the distal popliteal artery (black arrow) and reconstitution of the anterior tibial artery (white arrow). (b) Retrograde access is obtained using a micropuncture needle (arrow). (c) A through-and-through flossing guide wire is established by advancing the retrograde wire (white arrow) through the end hole of the antegrade catheter (black arrow) via a retrograde 3-F catheter (arrowheads) as a support catheter. (d) Completion angiogram after angioplasty shows in-line patency of and to the anterior tibial artery (arrows).


Citation: Sabri, S. S. et al. Retrograde Pedal Access Technique for Revascularization of Infrainguinal Arterial Occlusive Disease. Journal of Vascular and Interventional Radiology (2014). doi:doi: 10.1016/j.jvir.2014.10.008


Post Author: Luke Wilkins, MD