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BACKGROUND Endovascular therapy is playing an increasing role in the treatment of iliofemoral venous disease. Iliac stent patency is multifactorial, and current management is based on best clinical practices, varying by institution. AIM To evaluate how thrombophilia influences management and outcomes of patients who undergo venous stenting for thrombotic iliac vein compression syndromes. METHODS A retrospective observational analysis was performed on 65 patients with thrombotic iliac vein compression syndrome that underwent common iliac vein (CIV) stenting between December 2013 and December 2019 at a large academic center. Search criteria included CIV stenting and iliac vein compression. Non-thrombotic lesions and iliocaval thrombosis and/or occlusions were excluded. A total of 65 patients were selected for final analysis. Demographic information, procedural data points, and post-procedural management and outcomes were collected. Statistical analyses included Fisher's exact and Chi-square tests to compare discrete variables and the Wilcoxon rank-sum test to compare continuous variables between thrombophilia positive and negative patients. RESULTS 65 patients underwent successful balloon angioplasty and CIV stenting. Of these patients, 33 (50.8%) underwent thrombophilia testing, with 16 (48.5%) testing positive. Stent patency on ultrasound did not significantly differ between thrombophilia positive and negative patients at 1 mo (92.3% vs 81.3%, P = 0.6), 6 mo (83.3% vs 80%, P > 0.9), or 12 mo (77.8% vs 76.9%, P = 0.8). Immediately after stent placement, thrombophilia patients were more likely to be placed on dual therapy (aspirin and anticoagulation) or triple therapy (aspirin, clopidogrel, and anticoagulation) (50% vs 41.2%, P > 0.9), and remain on dual therapy at 6 mo (25% vs 12.5%, P = 0.5) and 12 mo (25% vs 6.7%, P = 0.6). There was no significant difference in re-intervention rates (25% vs 35.3%, P = 0.7) or number of re-interventions (average 2.3 vs 1.3 per patient, P = 0.4) between thrombophilia positive and negative patients. CONCLUSION Half of patients with stented thrombotic iliac vein compression syndrome and thrombophilia testing were positive. The presence of thrombophilia did not significantly impact stent patency or re-intervention rates.

Despite inferior vena cava (IVC) filter practice spanning over 50 years, interventionalists face many controversies in proper utilization and management. This article reviews recent literature and offers opinions on filter practices. IVC filtration is most likely to benefit patients at high risk of iatrogenic pulmonary embolus during endovenous intervention. Filters should be used selectively in patients with acute trauma or undergoing bariatric surgery. Retrieval should be attempted for perforating filter and fractured filter fragments when imaging suggests feasibility and favorable risk-to-benefit ratio. Antibiotic prophylaxis should be considered when removing filters with confirmed gastrointestinal penetration. Anticoagulation solely because of filter presence is not recommended except in patients with active malignancy. Anticoagulation while filters remain in place may decrease long-term filter complications in these patients. Patients with a filter and symptomatic IVC occlusion should be offered filter removal and IVC reconstruction. Physicians implanting filters may maximize retrieval by maintaining physician-patient relationships and scheduling follow-up at time of placement. Annual follow-up allows continued evaluation for removal or replacement appropriateness. Advanced retrieval techniques increase retrieval rates but require caution. Select cases may require referral to experienced centers with additional retrieval resources. The views expressed should help guide clinical practice, future innovation, and research.

This retrospective analysis reviews five patients with transjugular intrahepatic portosystemic shunt (TIPS) who underwent percutaneous microwave ablation of hepatocellular carcinoma between January 2017 and September 2020. Mean tumor diameter was 2.0 cm (range 1.3-2.9 cm), and mean tumor distance from TIPS was 2.3 cm (range 1.5-3.3 cm). There were no major adverse events, and the TIPS patency was 100% post-ablation. The technical success rate was 100%, and the complete response rate was 100%. In this small study, percutaneous microwave ablation appears safe and effective for the treatment of hepatocellular carcinoma in patients with TIPS in the short-term follow-up period.

Despite inferior vena cava (IVC) filter practice spanning over 50 years, interventionalists face many controversies in proper utilization and management. This article reviews recent literature and offers opinions on filter practices. IVC filtration is most likely to benefit patients at high risk of iatrogenic pulmonary embolus during endovenous intervention. Filters should be used selectively in patients with acute trauma or who are undergoing bariatric surgery. Retrieval should be attempted for perforating filter and fractured filter fragments when imaging suggests feasibility and favorable risk-to-benefit ratio. Antibiotic prophylaxis should be considered when removing filters with confirmed gastrointestinal penetration. Anticoagulation solely because of filter presence is not recommended except in patients with active malignancy. Anticoagulation while filters remain in place may decrease long-term filter complications in these patients. Patients with a filter and symptomatic IVC occlusion should be offered filter removal and IVC reconstruction. Physicians implanting filters may maximize retrieval by maintaining physician-patient relationships and scheduling follow-up at time of placement. Annual follow-up allows continued evaluation for removal or replacement as appropriate. Advanced retrieval techniques increase retrieval rates but require caution. Certain cases may require referral to experienced centers with additional retrieval resources. The views expressed should help guide clinical practice, future innovation, and research.

Purpose To evaluate the safety and efficacy of attempted percutaneous filter fragment removal during retrieval of fractured inferior vena cava (IVC) filters and to report outcomes associated with retained filter fragments. Materials and Methods Over a 5-year period, 82 consecutive patients presenting with a fractured IVC filter were prospectively enrolled into an institutional review board–approved registry. There were 27 men and 55 women (mean, 47 y; range, 19–85 y). After main filter removal, percutaneous removal of fragments was attempted if they were deemed intravascular and accessible on preprocedural computed tomography (CT), cone-beam CT, and/or intravascular ultrasound; distal pulmonary artery (PA) fragments were left alone. A total of 185 fragments were identified (81 IVC, 33 PA, 16 cardiac, 2 hepatic vein, 1 renal vein, 1 aorta, 51 retroperitoneal). Mean filter dwell time was 2,183 days (range, 59–9,936 d). Eighty-seven of 185 fragments (47%) were deemed amenable to attempted removal: 65 IVC, 11 PA, 8 cardiac, 2 hepatic, and 1 aortic. Primary safety outcomes were major procedure-related complications. Results Fragment removal was successful in 78 of 87 cases (89.7%; 95% confidence interval [CI], 81.3–95.2). There were 6 minor complications with no consequence (6.9%; 95% CI, 2.6–14.4) involving intraprocedural fragment embolization and 1 major complication (1.1%; 95% CI, 0.0–6.2), a cardiac tamponade that was successfully treated. The complication rate from attempted cardiac fragment removal was 12.5% (1 of 8; 95% CI, 0.3–52.7). Among patients with retained cardiopulmonary fragments (n = 19), 81% remained asymptomatic during long-term clinical follow-up of 845 days (range, 386–2,071 d). Conclusions Percutaneous removal of filter fragments from the IVC and proximal PAs is safe and effective overall, but attempted intracardiac fragment removal carries a higher risk of complication. Most residual filter fragments not amenable to percutaneous removal remain asymptomatic and may be monitored clinically.

The ongoing COVID pandemic raises many concerns as our healthcare system is pushed to its limits and as a consequence, Interventional Radiology training may be compromised. Endovascular simulators allow trainees many benefits to build and maintain endovascular skills in a safe environment. Our experience demonstrates a methodology to maintain IR training with use of didactic and simulation supplementation during the COVID-19 pandemic, which may be helpful for incorporation at other institutions facing similar challenges., Highlights • Endovascular simulation supplementation was successfully utilized during the COVID-19 pandemic within IR training. • A total of 52h of simulation were logged over by 6 trainees and instructor. Mean simulation time per trainee was 6h. • This educational program consisted of didactics and high-fidelity endovascular simulation.

Treatment of acute submassive pulmonary embolism (PE) with thrombolytic therapy remains an area of controversy. For patients who fail or who have contraindications to systemic thrombolysis, catheter-directed therapy (CDT) may be offered depending on the patient's condition and the available institutional resources to perform CDT. Although various CDT techniques and protocols exist, the most studied method is low-dose catheter-directed thrombolytic infusion without mechanical thrombectomy. This article reviews current protocols and data on the use of CDT for acute submassive pulmonary embolism.

The 2016 RAD-AID Conference analyzed the accelerated global activity in the radiology community that is transforming medical imaging into an effective spearhead of health care capacity building in low- and middle-income countries. Global health efforts historically emphasized disaster response, crisis zones, and infectious disease outbreaks. However, the projected doubling of cancer and cardiovascular deaths in developing countries in the next 15 years and the need for higher technology screening and diagnostic technologies in low-resource regions, as articulated by the United Nations' new Sustainable Development Goals of 2016, is heightening the role of radiology in global health. Academic US-based radiology programs with RAD-AID chapters achieved a threefold increase in global health project offerings for trainees in the past 5 years. RAD-AID's nonprofit radiology volunteer corps continue to grow by more than 40% yearly, with a volunteer base of 5,750 radiology professionals, serving in 23 countries, donating close to 20,000 pro bono hours globally in 2016. As a high-technology specialty interfacing with nearly all medical and surgical disciplines, radiology underpins vital health technology infrastructure, such as digital imaging archives, electronic medical records, and advanced diagnosis and treatment, essential for long-term future health care capacity in underserved areas of the world.

Medical imaging has gained increasing adoption in many low-resource regions of the world. Various informatics platforms and technology will play an important role in bridging the gap in imaging services accessible between low- and high-resource settings. PACS platforms have served as a tool that can provide tremendous benefit in low- and middle-income countries. Continual improvements in network infrastructure and declining hardware costs will also make development of sustainable imaging network solutions easier in the future.

Venous thromboembolism including pulmonary embolism and deep vein thrombosis leads to short- and long-term morbidity and in some cases mortality. Although treatment approaches vary among institutions based on local expertise, the employment of interventional techniques is of great interest. Several studies have shown clinical and physiological benefits from catheter-based techniques. However, these therapies are not without risk, especially with the use of powerful thrombolytic agents that increase the rate of bleeding. This chapter reviews the catheter-based techniques for the management of deep vein thrombosis and pulmonary embolism as well as the indications and complications of inferior vena cava filters.

Global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants, and solutions;involvesmanydisciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual

Current imaging technologies are capable of acquiring volumetric data, but they are limited by the flat 2-dimensional representation of complex 3-dimensional data. This pictorial report illustrates the potential role of interactive virtual reality (VR) that enables physicians to visualize and interact with image data as if they were real physical objects. Increasing availability of tools that make the VR environment a possibility could potentially be valuable in the interventional radiology suite.

The purpose of our Quality Improvement (QI) project was to evaluate the effectiveness of radiology-led didactics on efficiency and ordering practices in the emergency department. Residents of the emergency medicine (EM) program at Downstate Medical Center/Kings County Hospital (postgraduate years 1 - 4) participated in a didactic lecture series during the first two months of the 2013 academic year. Two fifteen-minute lectures with a question and answer session were designed to focus on radiation risk, American College of Radiology (ACR) appropriateness criteria and the department of radiology’s policies. A short survey questionnaire that included questions on ACR appropriateness criteria, radiology experiences and opinions/attitudes regarding radiology was distributed and analyzed before and after the didactic series. The average score for the knowledge-based technical questions on ACR appropriateness criteria was 60.5% initially and 76.4% post-lecture with an overall improvement of 25%, which was statistically significant (p < 0.0001). Following a short didactic lecture series, EM residents showed significant improvement of their knowledge of appropriate image utilization on the post-lecture survey. This highlights the need for dedicated radiology-led lecture series for EM residents. This type of program could be implemented yearly and expanded to other departments to promote interdepartmental commuication, increases radiology awareness, improves ordering practices and encourages appropriate imaging utilization.