Musculoskeletal interventions are routine in many radiology departments in developed countries, and also in some of the centers in Iran. These are in a wide variety of procedures from FNA to percutaneous tumor ablation and vertebroplasty.The purpose of this presentation is to cover the major current musculoskeletal interventional radiologic procedures. In this talk a summary of indications, usefulness, limitations and contraindications and a review of the last papers will be presented.

Management of failing hemodialysis access includes percutaneous or surgical repair, but angioplasty re-mains the primary technique for treatment. Indica-tion of management of failing hemodialysis access includes presence of a clinical and hemodynamic abnormality (eg, elevated venous pressure, decreased intra-access blood flow, prolonged bleeding following needle removal, presence of stenosis causing more than a 50% reduction in the luminal diameter of the vessel, clinical and angiographic findings which are both abnormal and correlative, arteriovenous fistulas that have failed to mature into useful vascular access within 3 months). Stents may be indicated with failed angioplasty and stenosis that recurs within 3 months after previously successful angioplasty.

Recently, a number of procedures for interventional radiology diagnosis and treatment have been developed by the radiologists. The “interventional radiology‟ refers to the therapeutic procedures performed under imaging guidance. The emergence of this specialty has been made possible by a lot of advances in the technology, imaging systems, and radiologists experience. interventional radiologists are physicians who are experienced in minimally invasive procedures and targeted treatments which have less risk, less pain and less recovery time in comparison with the surgery. Minimizing the patient discomfort, avoid of general anesthesia, lower incidence of morbidity and mortality, and de-creases the length and cost of hospitalization are some advantages of interventional radiology procedures. Similar to all medical fields, interventional procedures have been introduced and developed for the diagnosis and treatment of endocrinology procedures. In this article we aim to review and report our experience about the role of interventional radiology in venous sampling for endocrine diseases (such as parathyroid venous sampling, inferior petrosal sinus sampling, adrenal venous sampling, and venous sampling for islet cell tumors). In addition, interventional treatments of neuroendocrine cancer metastases to the liver, percutaneous ethanol injection therapy for secondary hyperparathy-roidism, treatment of hyperfunctioning thyroid nodules by percutaneous ethanol injection, radiofrequency ablation of the adrenal gland neoplasms, and also establishing a cGMP pancreatic islet processing facility have been discussed in this article.

Background: The increasing complexity and numbers of interventional fluoroscopy procedures have led to increasing patient radiation doses. Consequently, radiation protection of the patients undergoing X-ray procedures is essential. During any medical procedure that uses radiation, the as low as reasonably achievable principle should always be followed. Objectives: To investigate available shielding methods in an effort to further awareness and understanding of existing preventive measures related to patient exposure in interventional radiology. Methods: Searches were conducted to locate literature discussing the effectiveness of commercially available shields. Literature containing information regarding eye and thyroid shielding was identified. The selected studies were examined using the following topics as guidelines: the effectiveness of the shield (percentage of dose reduction), the shield’ s effect on image quality, arguments for or against its use (including practicality) and overall recommendation for its use in clinical practice. Results: Only a limited number of studies have been performed on the use of shields for the eyes and thyroid, but the evidence shows an overall benefit to their use. This study demonstrates how thyroid shields can be used to reduce dose to the thyroid by almost half. The use of thyroid and eyes shields is not routine but has been studied in patients during interventional procedures. The effect of shielding on image quality was not remarkable in a majority of studies. Although it is noted that more studies need to be conducted regarding the impact on image quality, the currently published literature stresses the importance of shielding in reducing dose. Conclusions: Available shields for the thyroid and eyes should be implemented in clinical practice. Further research is needed to demonstrate the prevalence of shielding in the clinical setting.

Background: Malfunctions of totally implantable central venous ports (TICVPs) have become a problem, as the usage of TICVPs has increased enormously. Objectives: This study evaluated factors related with catheter malfunctions of TICVPs. Patients and Methods: Between January 2010 and June 2012, 1, 740 TICVPs in 1740 patients (874 men and 866 women) with an average age of 57. 7  12. 8 years (range: 15-91 years) were implanted by an interventional radiology team at our institute. Catheter malfunctions were retrospectively analyzed. In the prospective study, we randomly allocated 176 patients to two kinds of TICVPs in a 1: 1 assignment ratio. The primary outcome was the malfunction of TICVPs. Results: In the retrospective study, the 32 malfunctioning TICVPs were caused by fibrin sheath formations (n = 15), chamber thrombosis (n = 8), TICVP rotation (n = 5), catheter migration (n = 2), and blood clots within the catheters (n = 2). Multivariate analysis showed that being female was a significant factor for poor patency rates of TICVPs (hazard ratio: 5. 06; 95% confidence interval (CI) 1. 32-19. 46, P = 0. 018). In the prospective study, two chamber thromboses occurred in Celsite® (n = 1) and Humanport® (n = 1). The primary patency rates of both Celsite® and Humanport® were 98. 9% at 6 months, respectively. Conclusion: Our data suggest that catheter malfunctions of TICVPs are more common in females than males. The incidence of TICVP malfunctions does not differ between the two devices (Celsite® vs. Humanport® ).

interventional radiologists are physicians who specialize in minimally invasive targeted therapies, offering the most in-depth knowledge of the less invasive therapies that are available and diagnostic and clinical experience across all specialties. interventional radiologists offer treatments for hepatobiliary diseases without significant side effects or damage to the adjacent normal tissue.We briefly introduce some of the interventional procedures in gastroenterology.

Background: Various endovascular treatment methods have been used to treat ruptured vertebral artery dissecting aneurysms (VADAs). However, the efficacy and long-term durability of the various endovascular techniques have remained unestablished. Objectives: The purpose of the present study is to report the therapeutic efficacy and long-term clinical and angiographic results of various endovascular treatment methods, and to evaluate the predictive factors of favorable outcomes. Patients and Methods: Between January 2010 and August 2014, 30 patients with ruptured VADAs were classified according to the dominancy of the affected vertebral artery (VA) and the involved major perforating vessels. Allotted endovascular therapy was performed for each of the ruptured VADA subtypes. Immediate angiographic and follow-up imaging results were retrospectively reviewed, and long-term clinical results were evaluated. Various clinical, angiographic, and procedural factors were evaluated to determine their associations with clinical outcomes. Results: Dissecting aneurysms involving the dominant VAwere found in five patients. Of 25 aneurysms involving the non-dominant VA, 12 lesions showed involvement of the posterior inferior cerebellar artery (PICA), and one lesion’ s origin was the anterior spinal artery. Stent-assisted coiling (SAC) was performed in seven patients, stent-only therapy (SOT) was conducted for six patients, and the remaining 17 patients were treated with internal coil trapping (ICT). Of the seven patients treated with SAC, five showed partial obliteration and four experienced recurrence. Two of the four patients with recurrence died. One patient with incomplete trapping for patency of the involved PICA experienced rebleeding. No recurrence was observed in six patients treated with SOT, or among 16 patients with ICT. The preoperative neurologic status (represented by the world federation of neurosurgical societies grading) and immediate post-treatment angiographic results were confirmed as significant predictive factors of clinical outcomes (P =0. 018 for both variables). Conclusion: Incomplete obliteration of a ruptured VADA using SAC was associated with a higher recurrence rate and fatal clinical outcomes. ICT is a useful technique that completely eliminates the risk of rebleeding. However, under a limited set of conditions, SOT can be an effective alternative.