Today's 8 am #UFE begging to leave hospital at 10.30 am....we found a middle ground 11 am

The secret 🤫: #RadialFirst and #SHNB

#Tweetorial on technique and troubleshooting....

🧵1/ Relevant anatomy:
Sup hypogastric nerve plexus- sympathetic nerve plexus anterior to L5 body
Aortic bifurcation-L4
Venous confluence- L5, L5-S1 disc (*overlies the plexus 😱)

2/

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/

#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/

Vectors or Vulnerable?

#Covid_19…the more you know…🤦‍♀️🤷‍♂️

What we know about MIS-C in children so far : Evidence, CDC alert and more…

🧵 1/ Minimal medical burden

Low incidence: 1.7-2%

Asymptomatic or mild symptoms, however can pass this virus onto high risk population (vectors)

Severe illness: rare, can occur with pre-existing medical conditions, but have better outcomes (compared to adults)

2/

“What the eye doesn't see and the mind doesn’t accept, DOES EXIST!”

👇 picture of the hands of Thomas Edison’s assistant. Later died from Cancer due exposure to the same ‘invisible’ X-Ray radiation

Why are we discussing this in 2020, during #Covid_19 ?

1/ Radiation is not visible to the human eye and neither is Coronavirus.

The size of the virus is about 0.1 um, smaller than a red blood cell and even some bacteria

Both can have devastating effects , if we do not protect ourselves

2/

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/

https://twitter.com/TedWJamesMD/status/1248271535816622080

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

⚡️ 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.

"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