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Case 13: Tunnelled Dialysis Cath insertion done elsewhere. Referred for no backflow. What next? . #irad #MedTwitter #MedEd SIR RFS SIR ECS Society of Interventional Radiology Keith Pereira MD, #VIrad Keerthi Prasad Kumar Madassery Lorenzo Patrone Mark Lessne, MD Srini Tummala MD FSIR FSVM Venkat Tummala MD MBA

Karan Manoj Anandpara

1,203 subscribers

11,457 次观看 • 2 年前 •via X (Twitter)

健康养生教育科学技术 #irad #MedTwitter #MedEd

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10 条评论

Cole Bahakel, MD 的头像

Cole Bahakel, MD2 年前

@SIRRFS @SIR_ECS @SIRspecialists @keithppereira @KprasMD @kmadass @vascularIR @LessneVIR @SriniTummala @t_intheleadcoat @_backtable @IVISymposium @Vascular_India @iRadRock @TheRealDoctorOs @monteromiguel @IRadPatwary @iRadBIR_Chennai Never seen a trans-venous PTEG access before

Peter Bream 的头像

Peter Bream2 年前

@SIRRFS @SIR_ECS @SIRspecialists @keithppereira @KprasMD @kmadass @vascularIR @LessneVIR @SriniTummala @t_intheleadcoat @_backtable @IVISymposium @Vascular_India @iRadRock @TheRealDoctorOs @monteromiguel @IRadPatwary @iRadBIR_Chennai Classic dilation from left IJ perf through bottom of left brachiocephalic. Pull over a wire and drop some coils at the perf site. Find who did it and educate.

Pulkit Rangarh 的头像

Pulkit Rangarh2 年前

@SIRRFS @SIR_ECS @SIRspecialists @keithppereira @KprasMD @kmadass @vascularIR @LessneVIR @SriniTummala @t_intheleadcoat @_backtable @IVISymposium @Vascular_India @iRadRock @TheRealDoctorOs @monteromiguel @IRadPatwary @iRadBIR_Chennai extravascular space. It occurs when wire is pushed and it penetrates through posterior wall. Take similiar jugular access , negotiate into IVC, take balloon catheter and put it at same site where there must be rent at crossing point. Slight inflation , remove previous catheter.

Keerthi Prasad 的头像

Keerthi Prasad2 年前

@SIRRFS @SIR_ECS @SIRspecialists @keithppereira @kmadass @vascularIR @LessneVIR @SriniTummala @t_intheleadcoat @_backtable @IVISymposium @Vascular_India @iRadRock @TheRealDoctorOs @monteromiguel @IRadPatwary @iRadBIR_Chennai Agree mediastinal placement- prob inject to check on esophagus . Curious where it left the vein… Seen 1 case of esophageal perf from tunneling …

Lorenzo Patrone 的头像

Lorenzo Patrone2 年前

@SIRRFS @SIR_ECS @SIRspecialists @keithppereira @KprasMD @kmadass @LessneVIR @SriniTummala @t_intheleadcoat @_backtable @IVISymposium @Vascular_India @iRadRock @TheRealDoctorOs @monteromiguel @IRadPatwary @iRadBIR_Chennai Easy diagnosis even on the xray.. catheter in the azygos.. remove and reposition. Is the SVC thrombus chronic? To try to aspirate/remove it should be considered to avoid SVC obstruction in the future...

Karan Anandpara 的头像

Karan Anandpara2 年前

@SIRRFS @SIR_ECS @SIRspecialists @keithppereira @KprasMD @kmadass @LessneVIR @SriniTummala @t_intheleadcoat @_backtable @IVISymposium @Vascular_India @iRadRock @TheRealDoctorOs @monteromiguel @IRadPatwary @iRadBIR_Chennai Felt it’s actually in the mediastinum. Not in a vein or collateral. As per the CT

radiollama 的头像

radiollama2 年前

@SIRRFS @SIR_ECS @SIRspecialists @keithppereira @KprasMD @kmadass @vascularIR @LessneVIR @SriniTummala @t_intheleadcoat @_backtable @IVISymposium @Vascular_India @iRadRock @TheRealDoctorOs @monteromiguel @IRadPatwary @iRadBIR_Chennai The final distal ct images are concerning for possible esophagus. Which is just plain weird.

Karan Anandpara 的头像

Karan Anandpara2 年前

@SIRRFS @SIR_ECS @SIRspecialists @keithppereira @KprasMD @kmadass @vascularIR @LessneVIR @SriniTummala @t_intheleadcoat @_backtable @IVISymposium @Vascular_India @iRadRock @TheRealDoctorOs @monteromiguel @IRadPatwary @iRadBIR_Chennai Yes. Looks like it’s in the paraesophageal soft tissue. In the mediastinum. Probably due to rough wire manipulation

James J. Wynn 的头像

James J. Wynn2 年前

@SIRRFS @SIR_ECS @SIRspecialists @keithppereira @KprasMD @kmadass @vascularIR @LessneVIR @SriniTummala @t_intheleadcoat @_backtable @IVISymposium @Vascular_India @iRadRock @TheRealDoctorOs @monteromiguel @IRadPatwary @iRadBIR_Chennai Obviously need to determine if esophageal perf is real. Water-soluble contrast study either fluoro or CT. If no leak, pull the catheter. If the esophagus is perforated, get your friendly esophageal surgeon involved to discuss mgmt.

Cassra N. Arbabi MD 的头像

Cassra N. Arbabi MD2 年前

@SIRRFS @SIR_ECS @SIRspecialists @keithppereira @KprasMD @kmadass @vascularIR @LessneVIR @SriniTummala @t_intheleadcoat @_backtable @IVISymposium @Vascular_India @iRadRock @TheRealDoctorOs @monteromiguel @IRadPatwary @iRadBIR_Chennai Does look a lot like it’s in the esophagus but that would be close to impossible to achieve, but hey who knows? Endoscopy and if no esophageal perf then just pull.

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