Discover and read the best of Twitter Threads about #irad

Most recents (22)

Recently, the cumulative stresses of #iRad work reached a fever pitch, & I began itching for some adventure. I planned out a 150 mile (240 km) route from Denver into the mountains to camp. I asked around, but no one else could go, so it became my first solo #bikepacking trip. Image
But first! I would have to pack. And I'm a VERY slow packer for these trips. There's a LOT to put on a bike for a trip like this. Bags on the frame, handlebar, fork, seat, top top, etc. I calculated I needed to carry 2.5 L of H2O and planned to filter river water several times. ImageImageImageImage
I slept restlessly the night before with thoughts of mountain lions, bears, thirst, mechanicals, and mountain rain storms battling my need for a good night's rest. I left later than expected, around 0900 am and got on the trail, a nice tailwind lifting my high spirits higher.
Read 22 tweets
3/ Clot is in a constant state of evolution. #Fibrin—> #Collagen.
 
Unfortunately many patients present in the subacute or late phase of #clot development which hinders many of our treatment approaches.
 
7️⃣days- 20% collagen

1️⃣5️⃣ days- 50% collagen

2️⃣1️⃣days- 80% (!!) collagen
Read 39 tweets
Thromboembolic disease has defined the last year for our practice. #COVID has given us the time and unfortunately the patients to refine our interventional strategies. I get asked from time to time to describe the steps involved in a basic #PE case. So here goes....(thread)
(I'll cover concepts in patient selection another time). This illustrative case is a mid 50-s male with acute onset dyspnea 3 weeks after testing positive for #COVID19. No syncope, no pertinent medical history. OSa in the low 80s on RA. HR 115. RV:LV Ratio ~1.5 #iRad (1/ )
CTA shows bilateral, predominantly lobar distribution PE. Probably a small evolving infarct in the left lower lobe. (2/ )
Read 21 tweets
1/ Welcome to the first part of a #Tweetorial series on #VenousDisease.

🩸To begin how about we talk about the main player in the game- C.L.O.T. (and why you should care about it)

#Cardiotwitter #Irad #fellows #fellowtwitter #medthread #clot #medtwitter #clottwitter
3/ All clots ARE NOT born equally! There is a difference! Image
Read 34 tweets
1/ NAME THAT #COMPRESSIONSYNDROME

Patient with left flank pain, pelvic pain, hematuria and gonadal varices

Your only imaging modality is vascular U/S....Lets find out!

A Mohan #Tweetorial

#RPVI #cardiotwitter #irad #vascular @HadyLichaaMD @t_intheleadcoat @TheNarulaSeries
2/ What’s going on here?? First name your structures #RPVI

SMA- superior mesenteric artery
AO- Descending Aorta
Lt renal VN- left renal vein

@CHICKVIR @Jonathan_PaulMD @iRadRock @keithppereira @Vascupedia_com @DrYanLiu
3/ Save this- transverse slice at the level of the renals! So much anatomy in such a confined space

#RPVI #cardiotwitter #IRAD #Vascular #foamed #cardioed #cardiology #ultrasound #pocus
Read 11 tweets
Did you adequately numb the peritoneum for your paracentesis?

If it looks like this then yes! Yes, you did. Congratulations. Your patient thanks you (and may ask for you by name next time!)

#ultrasound #irad #MedTwitter #MedEd #POCUS
For any intra abdominal needle passage, pain crossing the skin and peritoneum (sometimes muscles too) are worst. The 25G lido needle isn't too bad, but if you try to pass a 5 French without good local anesthesia, they're going to feel it.
Paracentesis is a great procedure for learning US/needle skills. Make sure you 👀your needle tip OVERLYING the deepest, echogenic, anterior abdominal wall layer and numb, numb, numb. If that layer pushes away from you, chase it with your needle!
Read 6 tweets
Kicking off multidisciplinary Research Consensus Panel (RCP) to finally investigate the ❓: what is the optimal medical therapy (OMT) following venous recan? Follow #VenousRCP throughout the day to learn more and contribute! #SIRFoundation @SIRRFS @SIR_ECS @JVIRmedia
🔴 Pathophysiology of venous thromboembolism #VTE
🟠Venous recanalization & stenting
🟡The mystery of medical therapy following recanalization
🟢Patency & outcome measures
🔵Economics & cost-effectiveness of treatment
🟣Future directions
#VenousRCP
🔴 ✅#VTE affects ~100 of every 100,000 people yearly in the US
✅Incidence of VTE ⬆️⬆️ exponentially with age, especially after 40
#Endovascular recan is a common tx; post-tx algorithms vary widely
✅More #epidemiology info @CircAHA bit.ly/37IptZh
@Pertconsortium
Read 24 tweets
We are pleased to introduce the first in a series of IR Procedure “Starter Kits.” These are very basic visual overviews of common procedures designed by the RFS for IR trainees. #SIRRFS #twittIR #IRad #OncoRad #RadRes #futurerads
𝗧𝗿𝗮𝗻𝘀𝗵𝗲𝗽𝗮𝘁𝗶𝗰 𝗮𝗿𝘁𝗲𝗿𝗶𝗮𝗹 𝗰𝗵𝗲𝗺𝗼𝗲𝗺𝗯𝗼𝗹𝗶𝘇𝗮𝘁𝗶𝗼𝗻 (𝗧𝗔𝗖𝗘) is a procedure that involves intra-arterial administration of chemotherapy, followed by an embolic agent, in order to induce necrosis of liver malignancy.
TACE is used as locoregional therapy for liver malignancies, both primary and metastatic.⁣ Listed here are the indications and contraindications of TACE.
Read 8 tweets
1
Sharing our invited review: Transjugular intrahepatic portosystemic shunt (TIPS) in #cirrhosis/World #Journal of #Gastroenterology. @SRajesh_IR helms 24-page colossus discussing exhaustively recent studies #livertwitter #MedTwitter #irad #GITwitter
Full: bit.ly/3ib7Frp Image
2
Topics we discuss include - variceal bleeding (incl ectopic), #ascites & #hydrothorax (incl chylous), #complications, new techniques, #stent size dilemma & extensive point of care algorithmic approaches in portal hypertension complications, eg: esophageal #variceal bleeding 👇 Image
3
#New techniques such as combined approach for difficult anatomy situation in TIPS in cirrhosis 👇 Image
Read 7 tweets
#livertwitter #irad #MedEd #MedTwitter
Large tortuous paraumbilical vein shunt in #patient with #Cirrhosis and #portalhypertension. @SRajesh_IR 👌
1/3 Image
Post coil (CARTO) and glue, complete disappearance of shunt ✌️
#phtsig #radiology #MedStudentTwitter
2/3 Image
#Tipss #procedure performed along with shunt occlusion, for recurrent #ascites 3/3
Complete resolution of portal hypertension complications 💯🎯 Image
Read 3 tweets
Orthopedic pre-op embo, transradial axillary flush arteriogram before next day reverse total shoulder arthroplasty. Catheter selection, embolic selection, outcome images to follow:
What is your preferred embolic in this case? Feel free to elaborate below! #IRad #IR #IO #OrthoIR #PalliativeIR #Embolization
Read 7 tweets
(1/22) Acute PE treatment. An ever evolving landscape.

How about a #tweetorial on acute pulmonary embolism (#PE) and how to use mechanical #thombectomy with @InariMedical #FlowTriever?? Lets goooooo!

#InariFellowsEdition #IRad #IC #cardiotwitter
Pic credit @Jonathan_PaulMD Image
2/ From @CDCgov data one American dies of a blood clot every....? #VTE #PE @PERTConsortium #InariFellowsForum
3/ Acute #PE stats

📊100,000–180,000 PE-related deaths annually in US

📊PE is the most preventable cause of death among hospitalized patients

📊3rd leading cardiovascular cause of death after coronary disease and stroke

⏱ 1 American dies of a blood clot every 6 seconds Image
Read 25 tweets
#livertwitter #irad
For patients with #cirrhosis without #liver failure, we believe in early and aggressive #treatment for #portal hypertension (increased liver pressure) with #TIPS and also knockout all big parasitic #shunts (done here with a plug) 1/3
@SRajesh_IR is 💯 on it Image
The #satisfaction of seeing those large bunch of #bleeding and #encephalopathy source #disappear is quite nice!
#MedTwitter #Medical #medicine
#MedicalStudent #MedEd
@SIRRFS 2/3 Image
In due course, we see the #spleen size reduce, as portal #hypertension comes under #control
Has anyone else noticed the dynamics of spleen post TIPS and its relevance? @keithppereira @CHICKVIR @SIRspecialists #radiology #aasld #easl #apasl
3/3 Image
Read 3 tweets
#crazy Useless #patient

1/n
Middle-aged man, loves his #family, #farming, drives a cab, #happy. Son & wife at #home. Father-son relationship strong as rock. One #morning, son finds father mumbling to self. Mother says he hardly slept
Mumbling becomes angry ramblings. #Clinical LAENNEC WAS TAUGHT THE IMPO...
2/n
Has very little #breakfast. Walks excessively. Goes and lies down, only to get up and walk again. Family interactions little. Sleeps well for 2 hours from 12 to 2PM. Lunchtime. Groggy #father gets on the lunch table and defecates near plates and food. Son and mother aghast.
3/n
Father has gone mad. Calls the friendly neighbor, brings his car, rushes to #Medical specialty #clinic nearby. Father disoriented. Son gets the Fword from his own father multiple times, he is shocked! Then comes hurling of abuses after which they restrain him in the car.
Read 15 tweets
More power to #irad
#Bleeding #varices and plug assisted transvenous #occlusion by @SRajesh_IR
Varices dissappear (arrows)
Wonderful to see how portal vein size increases (B➡️D) after shunt occlusion. #interventional #MedTwitter #radiology #livertwitter #GITwitter
1/2 Image
Similarly, intrahepatic #portal vein caliber increases(B➡️D), making further #TIPS procedure technically more amenable. Large shunts are like blood parasites for portal vein. Shunt+varices long gone! (circled, A➡️C) #cirrhosis #MedTwitter
#hepatology #irad @SIRspecialists
2/2 Image
Read 3 tweets
I’ve never done the #tipsfornewdocs thing…So here goes

If you’re like me, the transitions to residency and fellowship were much easier than into practice. I, like most #iRad s learned much more in the first few years in practice than all of training. Heres my summary: (thread)
(1/) It’s often difficult, but absolutely critical to solicit input from your colleagues, show them your cases, ask questions. Accept when your way isn’t the best. They've found success in the environment that you now work. Let their experience help your patients too #iRad
(2/) Focus on your passion: For me, taking care of cancer patients is all I’ve ever really wanted to do... Its super personal and important to me. I have found that success (referrals and good outcomes) comes easier when doing what you're most passionate about #iRad
Read 11 tweets
Highlights Day 1 of #SIR20VIR, #Irad Interventional virtual meeting!

#MedTweetorial

⚫️ 1.Scientific Session
a. 🟡 Dialysis Related
b. 🟢 Others
🔴 #PAD-CLI Bootcamp
🔵 Practical Controversies in #PAE

(Long thread, use color code to jump to relevant sections)

1/
🟡 1a Dialysis related

Abstract of the year:

Are PTFE covered stents going to be standard of care to address the venous outflow stenosis in AV fistulae (AVeNEW) and AV grafts (AVeVA)?

Results from Dr Bart Dolmatch

2/
🟡 1a Dialysis related

CONCERTO (COmbiNing Cutting and drug-Eluting balloon for Resistant arteriovenous fistula sTenOsis) Pilot Study showed great promise for use of the combination therapy for AVF

First Author:
Mark Wang, Singapore General Hospital

3/
Read 16 tweets
#LiverTwittIR #MedEd #Tweetorial

Management of post‐TIPS refractory Hepatic Encephalopathy (HE)

🟢 Definition
🟡 Prevention
🔵 Medical Rx
🔴 Endovascular approach

1/
🟢 HE maybe:
Covert: Minimal or West haven Gr 1
Overt: West Haven Gr 2-4 which maybe episodic, recurrent (bouts within 6 mo) or persistent ( behavioral changes present with intermittent overt HE)

2/
Why does post-TIPS HE occur?

1.Shunting of blood away from liver- decreases 1st pass clearance of intestinal toxins (ammonia)
2. Upregulation of intestinal glutaminase activity- Increase ammonia production

1yr incidence 10-50%
New/ worsening 13-36%
Severe 1-3%

3/
Read 11 tweets
Siguiendo un poco la línea del famoso historiador de Medicina en @Twitter @cateterdoblej (con sus hilos impresionantes). He tomado el tiempo para hacer un Hilo en relación a la Radiología Intervencionista. #Irad
Conocéis un famoso fontanero-médico. Todos conocemos quien es Dr. Mario. Pero no muchos conocen al padre de la radiología intervencionista el #DrCharlesDotter. Quien dijo "Si un fontanero puede hacerlo con las tuberias, nosotros podemos hacerlo en los vasos sanguíneos".
El Dr. Dotter, fue el pionero de tratamientos percutáneos a nivel de arterias y otros órganos. Brillante #RADIOLOGO que realizaba procedimientos diagnósticos en el Hospital Universitario Health & Science de Oregon.
Read 16 tweets
Great #DistanceMedEd about Mx of Variceal bleeding from @TedWJamesMD and thanks for this invite!

TIPS, BRTO and BATO - 🤦‍♀️Too many puzzling acronyms?

Lets break this down for you from #Irad perspective with a #Tweetorial

1/
2/

TIPS: basic overview of variceal anatomy and flow dynamics ( will help understanding BATO and BRTO later)

Normal Liver: hepatopedal flow
Cirrhotic Liver: hepatofugal flow
TIPS: Restored hepatopedal flow
3/
TIPS performed since 1982, but whats 🔥 ?

Contraindications ⬇️ with time. Why? Newer #Irad techniques

TIPS now possible in chronic Portal vein thrombosis, specially relevant as these patients not transplant eligible

High technical success, 39% underwent transplantation
Read 10 tweets
⚡️ Published @JVIRmedia ⚡️, will hopefully help #Irad #InterventionalSpecialists with patient care after #UFE

"Intraprocedural Superior Hypogastric Nerve Block (#SNHB) is safe, effective, significantly reduces pain, need for opioids and allows same-day discharge #UFE"

Thread 👇
1/ YOU CAN DO IT! 🤜 🤛

#SNHB technique: Technical success 87% , which included operators who were not initially experienced with this procedure.
2/ #SNHB HELPS WITH PAIN CONTROL 💊

97.1% of patient with #SNHB DID NOT NEED PCA pump

Of patients that needed opioids, average dose was ONLY 7.5 MME
Read 7 tweets
"What is the best Venous Access Device for my patient?"

An #InterventionalRadiology (#Irad) #Tweetorial to address a frequent clinical dilemmas for #Medtwitter and #NurseTwitter

#FOAMed
1a/

Type of VAD:

PIV: 3-6 cm, enter and terminate in peripheral veins.

US-PIV: US to reach deep veins when superficial veins difficult to palpate, ≥8 cm

Midline catheter: 7.5-25 cm, inserted basilic/cephalic vein), terminating short of subclavian. 🚫 vesicant infusions
1b/

CVC: duration 7-14 d, direct puncture of internal jugular, subclavian, or femoral veins.

TC : diff from CVC, seperate insertion site in upper chest and venipunture in neck
⬇️ risk of infection due to cuff
👍 location for catheter care
Read 15 tweets

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