Introduction

Article Outline

• Copyright

There are numerous medical emergencies that arise that may require evaluation and/or management using catheter-based or endovascular techniques. Often the patient has been initially evaluated by other means and may have had failed treatment attempts from other clinical services. In such circumstances, the interventional radiologist is often called on to use his or her skills to aid in the definitive diagnosis and treatment of these patients. In some emergency situations, a catheter-based intervention is the only treatment option, and this requires that the interventional radiologist assumes the roles of both a consultant and a primary specialist.

In this issue of Techniques in Vascular and Interventional Radiology, my colleagues and I from the Massachusetts General Hospital in Boston, MA have attempted to address various medical emergencies that may require the services of the interventional radiologist. I describe the emergency evaluation and management of patients who present with acute gastrointestinal hemorrhage that is refractory to medical and/or endoscopic therapy. Dr Sanjeeva Kalva, Dr Gloria Salazar, and I address a subset of patients who may present with acute gastrointestinal hemorrhage because of portal hypertension and examine the role of the transjugular intrahepatic portosystemic shunt in the emergency management of these patients. Dr Salazar and I provide an overview of various types of acute vascular trauma and describe the current endovascular treatment options for vascular injuries. I discuss acute limb ischemia and outline an approach to evaluating and treating this limb- and potentially life-threatening emergency. Dr Kalva reviews the evaluation of patients who present with massive hemoptysis and the therapeutic role of transcatheter bronchial artery embolization. Obstetrical and gynecologic emergencies that may require transcatheter management are discussed by Dr Gloria Salazar, Dr John Petrozza, and me, while Dr Stephan Wicky describes the current role of catheter-directed and percutaneous mechanical thrombolysis in treating acute deep venous thrombosis. Drs Raul Uppot and Benjamin Pomerantz complete the issue with their respective discussions of acute urinary obstruction and emergency biliary interventions.

I wish to thank all of my colleagues at the Massachusetts General Hospital for their valuable contributions and I hope that you find this issue of Techniques in Vascular and Interventional Radiology relevant to your daily practice in the evaluation and management of patients who present with a variety of “on-call” emergencies.