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#61
27.06.2009, 14:41
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Arterio-venous fistulas
These abnormal vascular connections can be congenital, spontaneous or traumatic. Treatment of congenital lesions is a challenge, as these have multiple, diffuse anastamoses with the surrounding vasculature.28 Traumatic lesions can also be difficult to treat, in part due to the urgency of treatment required in order to prevent life-threatening haemorrhage, neurological deficit or visual complications. These lesions, such as the carotid to cavernous sinus fistula occurring after head injury, are also often inaccessible surgically. The principle of treatment of arterio-venous fistulas is preservation of the normal vasculature where possible, while ensuring that both the distal and proximal vessels of the fistula are occluded. Various treatment modalities have been described, including embolization with detachable balloons, particles or sclerosants, using both arterial and venous approaches, as well as placement of endovascular stents.28–30 Proper planning of treatment is the key to success, and again requires close cooperation between the interventional radiologist and the head and neck surgeon. Venous sampling In recent years, a minimal access approach to parathyroidectomy for the treatment of primary hyperparathyroidism has evolved, making preoperative localization of the abnormal parathyroid gland increasingly important. The usual techniques employed for this include combinations of sestamibi, ultrasound, computerized tomography (CT) and magnetic resonance (MR) scans. When necessary, usually if the above techniques have not convincingly localized the affected gland, or in re-operative cases, a further technique available is that of intra-operative selective venous sampling. In this technique, the veins draining the parathyroid glands can be catheterized and blood sampled for parathyroid hormone. Elevated levels identify the abnormal gland and can be seen to return to normal after surgery. This technique, though invasive, has a high sensitivity and accurately predicts patients who have been successfully cured.31 Complications of interventional radiology It is well recognized that interventional radiology procedures carry a risk of complications higher than that of angiography alone. Immediate complications include arterial puncture site haematoma, embolic or ischemic neurological deficits including visual disturbance, and, rarely, arterial rupture or contrast allergy. Later complications include delayed ischaemia which may present with neurological sequelae, including cranial nerve deficit, as well as pain and skin necrosis or paraesthesia.32,33 Technological advances in the size and design of microcatheters has reduced the trauma and interruption to normal vascular flow that can be associated with interventional vascular procedures. In addition, access to much smaller vessels is now possible, allowing for highly selective vascular treatments, and reducing the incidence and severity of many of the possible complications. Infections may occur, those occurring around endovascular stents being particularly difficult to manage.34 It must be remembered that, in many cases, similar complications can occur following surgical treatment. The treating radiologists and surgeons must therefore include the consideration of these risks in their decision-making process. The future Many of the most exciting advances in interventional radiology are in the treatment of malignant diseases. These applications include intra-arterialchemotherapy, radiofrequency ablation of tumours and catheter-directed gene therapy.35 There is currently much research into the role of endovascular carotid artery stenting in the treatment of carotid vascular disease, with comparisons to surgical carotid endarterectomy.36 This is a controversial area, and results of further studies are awaited. It is certain that with the continual evolution of imaging technology, improved design of microcatheters allowing increasingly selective vascular access, and the increasing availability of interventional radiology services, their use will expand.37 As the specialty grows, it will be possible to safely offer more procedures on an outpatient basis.38 This will require increasing cooperation between specialties, and in the future some authors predict direct referrals to interventional radiology from general practitioners.39 Conclusion The role of interventional radiology in the treatment of head and neck conditions is increasing, but remains controversial. In some cases, such as the treatment of the carotid blowout syndrome, endovascular treatments have been shown to be superior to surgical treatment, and are rapidly becoming the gold standard for cases where intervention is appropriate. In most cases, as in the preoperative embolization of tumours or in parathyroid venous sampling, interventional techniques and surgery can be used as complementary therapies. In some conditions, such as in the management of epistaxis, the exact role of endovascular therapies is still debated. Head and neck surgery trainees must continue to be taught the necessary techniques to deal effectively with all of these conditions, but must also understand the role of interventional radiology in order to be able to offer the highest possible quality of care to their patients. 
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#62
27.06.2009, 14:48
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[Ссылки доступны только зарегистрированным пользователям ]
[Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ]
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#63
29.06.2009, 09:13
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Уважаемый FRSM! А можно сию статейку в .pdf формате выложить на какой нибудь файлообменник?
Заранее спасибо! -- С Уважением, Мальцев А.А.
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#64
02.07.2009, 03:29
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Цитата:
Я с этим не согласен. Не смотря на то, что сам по ординатуре/аспирантуре/сертификату1/сертификату2 - сердечный и сосудистый хИрург. -- С Уважением, Мальцев А.А.
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#67
13.07.2009, 09:25
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Извиняюсь, но новостей, похоже, нет и не предвидится?
Означает ли это, что действует прежний механизм подготовки (серд-сосуд хирург - первичка по рентгенологии - сертификационный цикл у Юрий Ильича)? Есть ли альтернатива?
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#68
13.07.2009, 09:31
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Цитата:
Это слишком сложный вопрос для понедельника  .
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#69
13.07.2009, 09:55
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Новости как раз есть. Но они пока не утверждены, хотя выложены на всеобщее обозрение. Причем, если это будет утверждено, наконец будут сняты все вопросы. Чему лично я очень рада.
[Ссылки доступны только зарегистрированным пользователям ] Рекомендую скачать приложение.
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#70
13.07.2009, 10:43
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Вау!!! Ну наконец-то!!!! Из кардиолога МОЖНО стать рентгеноэндоваскулярщиком!!!!!
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#72
13.07.2009, 11:25
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Да это же просто всеобщий праздник будет, если утвердят.
 Там же получается, что кардиолог таки может делать Эхо-КГ (причем обоими путями, и через УЗ-диагностику, и через функциональную диагностику).
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#74
13.07.2009, 14:34
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Да, вот так всегда. Все рады, а гонцу за хорошую новость даже чаю не налили...
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Линейный вид
