Introduction

Article Outline

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Techniques in Vascular and Interventional Radiology is geared mainly toward physicians interested in image-guided minimally-invasive therapies. Each issue of the Journal stresses the technical nuances, operative skills, and “how to” insights surrounding interventions in a particular organ or disease state. These various procedures and treatment modalities almost always require adjunctive therapies such as preprocedural hydration & medication, intraprocedural sedation & anticoagulation, and post procedural medical therapies that enhance, maintain, prevent, or treat certain effects of interventional procedures. Gathering this information from various sources, often in specialty journals not commonly read by the interventionalists, can be a time consumoing process. Therefore, in this issue of the Journal, we have concentrated on providing updates on, and practical approaches to some common problems encountered in the interventional suite.

One of the common problems encountered during diagnostic and therapeutic procedures needing iodinated contrast medium is the issue of contrast-induced nephropathy. In this issue of TVIR, Al-Ghonaim and Pannu provide an excellent discussion of the epidemiology, risk factors, preventive measures, and management strategies for this potentially devastating problem.

Similarly, prevention and treatment of infectious complications of various procedures is an important topic in the current practice of interventional medicine. In separate articles, Ryan and Smith provide in depth reviews of the current practices in prevention and treatment of common infections resulting from these procedures. Based on their reviews, they recommend practical approaches for various procedures and conditions that the reader will undoubtedly find very useful.

Common to all interventional procedures is the use of intraprocedural sedation. While this is done to minimize patient discomfort and improve compliance, sedatives can compromise patients’ cardiopulmonary and cognitive status. Familiarity with the mechanisms of action, risks, and management of potential complications of commonly used sedatives is, therefore critical in safe administration of these drugs. Shabani’s article in this issue provides a basic review and a practical guideline for administration of minimal and moderate sedation by the interventionalist.

Basic to all endovascular procedures is the prevention of acute clot formation. Maclean provides recommendations for the use of bivalirudin, a direct thrombin inhibitor, during complex peripheral interventions. Similarly, the role of antiplatelets in prevention of acute thrombus formation and adverse ischemic events during and after vascular procedures is now well established. Given the importance of antiplatelet therapies and the availability of multiple such regimens, Mahmud and Ang summarize the current understanding regarding these medications and discuss the issue of antiplatelete resistance.

In the recently published Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) document, risk factor modification is recognized as the first step in the management of these patients. Important among them is the diagnosis and treatment of dyslipidemia. Given the plethora of information available on the relationship between hypercholesterolemia and the development of cardiovascular disease, statin therapy assumes a central role in the management of patients before and after peripheral vascular interventions. In this issue of TVIR, Blum addresses the management of dyslipidemia with the powerful class of drugs, the statins, reviewing the rationale for as well as the practical considerations in the use of these agents.

Sudden patient decompensation in the IR suite is fortunately a rare problem. Given the increasing complexity of the patients and their problems encountered in the modern IR practice, however, this may become a more common problem for the interventionalist to deal with. Early recognition and response to hemodynamic instability will improve outcome. This issue is addressed by Hanks who provides a basic guide for initial management of such patients.

The current issue of TVIR is intended to provide a practical guide to the above mentioned common problems and concentrate the solutions in one issue. We hope that the readers of the Journal find this approach useful.