Outpatient Care of the Interventional Radiology Patient

The current trend among interventional radiologists is to be actively involved in the pre- and post-procedure care that surrounds many of our procedures. For this to occur, defined office space that is set up in such a way that is conducive to outpatient consultation and post-procedure visits is required. In addition, appropriate support staff such as midlevel providers (including nurse practitioners and physician assistants) and a receptionist are needed to make the entire system work. Finally, dedicated time to focus on direct patient care is mandatory. Equally important is understanding the processes that occur in the background of a typical procedural encounter, including generating referrals, obtaining insurance pre-authorization, managing medical records, and communicating with referring physicians, all of which are expected to take place when managing patients in an outpatient setting. When these components are in place, it becomes possible for an interventionalist to successfully develop an outpatient office and to meet the expectation that patients will be seen before and after procedures by the practitioner performing that procedure

Radial Artery Harvest: A Potential Cause of Arteriovenous Access‐Associated Hand Ischemia

Hand ischemia has multiple causes. In this article, we report an additional factor that can induce hand ischemia in hemodialysis patients. A 64‐year‐old white man with coronary artery disease underwent a coronary artery bypass graft procedure using the left radial artery as the bypass graft. Several months later, a left extremity Gracz fistula was created for arteriovenous access. Ever since dialysis was performed via the fistula the patient has experienced a cold hand and pain during dialysis that was somewhat relieved by wearing a woolen glove while on dialysis. Absence of the radial artery in the context of an ipsilateral arteriovenous access was highlighted as a possible etiology. A complete arteriography to determine the presence of stenoses, distal arteriopathy, and true steal was recommended, but the patient refused to undergo any investigation or procedure and instead decided to continue wearing the glove during the treatment. A plan for close follow‐up and possible interventions in the event of worsening pain/ulceration was agreed upon. Radial artery harvest can result in hand ischemia if an ipsilateral arteriovenous access is created. We suggest that the contralateral extremity should be considered if an arteriovenous access is required to minimize this risk of this phenomenon

The Interventional Radiology Clinic: What You Need to Know

It is increasingly recognized that clinical management in interventional radiology is necessary. To effectively participate in such management requires patient management infrastructure. The cornerstone of this effort is the clinical office

Blood Pressure Recordings During Hemodialysis Access Interventions: Implications for Acute Management

A retrospective study evaluating the pattern of blood pressure and its related complications before, during, and after percutaneous hemodialysis interventions was performed in patients presenting with asymptomatic hypertension. Hemodialysis patients undergoing percutaneous interventions including tunneled hemodialysis catheter insertion, percutaneous balloon angioplasty and thrombectomy procedure, and stage II hypertension (systolic blood pressure ≥160 mmHg) were included in this analysis. Blood pressure medications were not used while midazolam and fentanyl were routinely administered. Patients were followed for up to 4 weeks to monitor any complications. The mean blood pressure before, during, and after the procedures were 185 ± 18/96 ± 14, 172 ± 22/92 ± 15, and 153 ± 25/87 ± 14, respectively. There was a statistically significant difference between the blood pressure readings before and after the procedure (before = 185 ± 18/96 ± 14, after = 153 ± 25/87 ± 14; p = 0.001). None of the patients had a stroke, myocardial infarction, or acute pulmonary edema before, during, or after the procedure or during the 4‐week follow‐up period. A significant reduction in blood pressure was observed after the procedure without the administration of any antihypertensive medication. These results suggest that the reduction in blood pressure observed after percutaneous dialysis access interventions (particularly in the presence of midazolam and fentanyl) may make it unnecessary to treat asymptomatic hypertension prior to these procedures