Techniques in Vascular & Interventional Radiology RSS feed: Current Issue. Interventional radiology is an area of clinical diagnosis and management that is highly technique-oriented. Therefore, the format of this quarterly journal, which combines the visual impact of an atlas with the currency of a journal, lends itself perfectly to presenting the topics. Each issue is guest edited by a leader in the field and is focused on a single clinical technique or problem. The presentation is enhanced by superb illustrations and descriptive narrative outlining the steps of a particular procedure. Interventional radiologists, neuroradiologists, vascular surgeons and neurosurgeons will find this a useful addition to the clinical literature. Techniques in Vascular and Interventional Radiology is a quarterly review publication for physicians and allied health professionals interested in image-guided minimally-invasive therapies. Its mission is to improve patient care by educating interventionalists on the latest techniques in catheter-based therapies from experts in the field. 2010 Topics , Volume 13 March Peripheral Arterial Interventions Pena June Renal, Adrenal and Urologic Interventions Part III Saad September Radiation Safety Dixon December Pediatrics I Sidhu I http://www.techvir.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Techniques in Vascular & Interventional Radiology1089-2516144December 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.techvir.com/article/PIIS1089251611000862/abstract?rss=yesEditorial Board10.1053/S1089-2516(11)00086-2Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5iihttp://www.techvir.com/article/PIIS1089251611000886/abstract?rss=yesPrevious Topics10.1053/S1089-2516(11)00088-6Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5iiiihttp://www.techvir.com/article/PIIS1089251611000874/abstract?rss=yesTable of Contents10.1053/S1089-2516(11)00087-4Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5iiiiiihttp://www.techvir.com/article/PIIS1089251611000680/abstract?rss=yesThe rapidly aging population and increased lifespan of individuals with chronic disease have resulted in an explosion in the demand for central venous access. Procedures once rare outside of the intensive care unit and operating room are now commonplace. For some, this responsibility represents a challenging burden in terms of coverage demands. For many, it represents a new service line with attractive economic potential. For patients, however, it more and more frequently represents an essential ingredient to the successful management of their care.IntroductionMichael V. Beheshti10.1053/j.tvir.2011.05.001Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5183183http://www.techvir.com/article/PIIS1089251611000692/abstract?rss=yesCentral venous access has become a mainstay of modern interventional radiology practice. Its history has paralleled and enabled many current medical therapies. This short overview provides an interesting historical perspective of these increasingly common interventional procedures.A Concise History of Central Venous AccessMichael V. Beheshti10.1053/j.tvir.2011.05.002Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5184185http://www.techvir.com/article/PIIS1089251611000722/abstract?rss=yesNon-tunneled central venous access has become an important tool in the management of the sick patient, particularly in the intensive care unit. Image guidance allows more precise placement of lines with overall lower complication rates compared with guidance by physical landmarks. The use of image guidance has brought a procedure traditionally performed by surgeons into the realm of the interventional radiologist. Techniques for placement of non-tunneled central venous catheters, hemodialysis catheters, and peripherally inserted central catheter lines will be discussed.Principles of Non-Tunneled Central Venous AccessHui-Yong Chung, Michael V. Beheshti10.1053/j.tvir.2011.05.005Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5186191http://www.techvir.com/article/PIIS1089251611000758/abstract?rss=yesTunneled cuffed catheters provide reliable and instant long-term intravenous access for a large variety of therapeutic purposes, including chemotherapy, parenteral nutrition, and apheresis. The most frequent application is for patients with renal failure as an access device for hemodialysis. In this capacity, the rate of catheter use has remained stable in the United States, despite the promotion of arteriovenous fistulas and arteriovenous grafts. The latter 2 procedures achieve superior longevity and much higher cost-efficiency. Tunneled catheters, however, serve as bridging devices during maturation of newly placed arteriovenous fistulas or as the final option in patients in whom fistulas and grafts have failed. High-quality vascular access is a hallmark of interventional radiology, and its significance for patient care and for our specialty cannot be overestimated. Familiarity with basic concepts of the device and procedural techniques are crucial to achieve successful long-term venous access. The following article demonstrates key concepts of tunneled venous catheter placement by means of dialysis, inasmuch as dialysis catheters represent the most commonly placed tunneled central venous catheters. The principles of placement and techniques utilized, however, are applicable to devices that are used for chemotherapy or parenteral nutrition, such as the Hickman, Broviac, Groshong, or tunneled peripherally inserted central catheters.Principles of Tunneled Cuffed Catheter PlacementWolf Heberlein10.1053/j.tvir.2011.05.008Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5192197http://www.techvir.com/article/PIIS1089251611000746/abstract?rss=yesThe introduction of totally implantable subcutaneous devices in the early 1980s provided patients with secure, reliable venous access and also gave them the ability to move more freely and have a more normal lifestyle with these devices in place. The most common totally implantable device used today is the subcutaneous port. These ports consist of an injection port connected to a catheter. Ports provide a number of advantages compared with other venous catheters; the most important is the reduced risk of infection. These devices have significantly lower rates of infection than nontunneled and tunneled catheters. Additional advantages include less frequent irrigation and minimal home care, and they are less prone to environmental or cutaneous contamination when not being accessed. This article will focus on the placement of these ports.Principles of Subcutaneous Port PlacementShaun J. Gonda, Ruizong Li10.1053/j.tvir.2011.05.007Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5198203http://www.techvir.com/article/PIIS1089251611000710/abstract?rss=yesThe most common venous access procedure performed in children and infants is the peripherally inserted central catheter, or “PICC.” Placement of a PICC affords patients stable long-term venous access for medication administration and blood draws. The Interventional Radiology team faces particular challenges in the placement and management of these catheters in a pediatric population. This article discusses our institution's step-by-step approach to operating a hospital-wide PICC service.Peripherally Inserted Central Catheter Placement in Infants and ChildrenLeah E. Braswell10.1053/j.tvir.2011.05.004Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5204211http://www.techvir.com/article/PIIS108925161100076X/abstract?rss=yesThis paper provides readers with a basic understanding of the types of central venous access–associated infections as well as appropriate diagnostic techniques. Preventive measures are the most effective way to reduce rates of catheter-associated infection and are discussed in detail. Diagnosis and treatment of each type of infection are reviewed for nontunneled central venous catheters, tunneled dialysis catheters, and venous access ports. Readers should be able to employ the methods described in this paper to reduce the rate of central venous access–associated infections at their hospitals.Diagnosis and Treatment of Central Venous Access–Associated InfectionsMary E. Meek10.1053/j.tvir.2011.05.009Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5212216http://www.techvir.com/article/PIIS1089251611000709/abstract?rss=yesVenous access is 1 of the most common interventional procedures in the USA. Using image guidance in the last 2 decades, obtaining venous access has become increasingly routine, and the complications commonly associated with the procedure have significantly decreased. However, interventional radiologists still encounter both early and late complications routinely associated with both central and peripherally inserted access devices. This article discusses the most common and some unusual complications seen with the placement of these devices. We also briefly discuss the management of these complications.Evaluation and Management of Central Venous Access ComplicationsSadaf T. Bhutta, William C. Culp10.1053/j.tvir.2011.05.003Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5217224http://www.techvir.com/article/PIIS1089251611000734/abstract?rss=yesFor patients who need long-term central venous access but who have developed obstruction of the usual central veins, “salvage” access techniques offer successful alternatives. These techniques include translumbar inferior vena cava access, transhepatic inferior vena cava access, catheterization of small venous collaterals, and recanalization of occluded veins. Inferior vena cava access techniques allow a range of devices to be placed, including ports, infusion catheters, and hemodialysis catheters. Collateral vessels may be too small to allow for large-caliber devices, such as hemodialysis catheters. Success rates for these access techniques are high and complications are infrequent. These access routes are in general quite durable. Adults and children can be treated. Once placed, devices are managed and used as they would be for any routinely placed venous access device.Venous Access Salvage TechniquesDonald F. Denny10.1053/j.tvir.2011.05.006Techniques in Vascular & Interventional Radiology 14, 4 (2011)2011-12-01Techniques in Vascular & Interventional Radiology2011-12-01144S1089-2516(11)X0004-5225232