Flavius_IR

In case anyone asks "does this treatment work?": Pre- and 2y post- SMA stenting #irad

@ChengaziMD @t_intheleadcoat @keithppereira @kmfitzMD @kmadass @_backtable @AustinBourgeois @Quinn_Meisinger @NoLimitIR @ElmasriFakhir @GreggKhodorov We just add head to diaphragm CTA + Doppler infrainguinally. Found a few dissections of the vertebrals, one carotid. For another recent case that started with just EIA we found SMA and intracranial aneurysms.

@Flavius_IR @t_intheleadcoat @keithppereira @kmfitzMD @kmadass @_backtable @AustinBourgeois @Quinn_Meisinger @NoLimitIR @ElmasriFakhir @GreggKhodorov Head to toe CTA?

@ChengaziMD @t_intheleadcoat @keithppereira @kmfitzMD @kmadass @_backtable @AustinBourgeois @Quinn_Meisinger @NoLimitIR @ElmasriFakhir @GreggKhodorov Indeed, hard to differentiate. I had a similar case recently where scanning the rest of them yielded quite a few other important vascular abnormalities.

@Flavius_IR @t_intheleadcoat @keithppereira @kmfitzMD @kmadass @_backtable @AustinBourgeois @Quinn_Meisinger @NoLimitIR @ElmasriFakhir @GreggKhodorov Presented from an outside hospital with no available history. The linear configuration of these was a bit suspicious but my leading thought was SAM or other vasculitis

@subbiah_doctor Right nephrectomy + adrenalectomy for ?GSW ?stab ?RCC

Can you guess what happened?

@ChengaziMD @t_intheleadcoat @keithppereira @kmfitzMD @kmadass @_backtable @AustinBourgeois @Quinn_Meisinger @NoLimitIR @ElmasriFakhir @GreggKhodorov Definitely not. You did the right thing. 👏 The liver will most likely survive on the PV. Whereas the patient might not have done after another bleed. Also, underlying E.Danlos? Or something similar?

Ah I didn’t see any active extrav, but I can upload CTA tomorrow - she had extensive portahepatis hematoma and hemoperitoneum but I never saw active bleeding. Clinically it was happening though I treated the three saccular aneurysms and debated leaving the fusiform to right alone to perfuse more liver, but ultimately ended up taking it out also Would you have staged it?

@AustinBourgeois According to some literature, they/we should.

@Flavius_IR Yeah these were all failed endoscopy. To my knowledge nobody is using PBD as first line access anywhere

14 biliary drains last month. Concerning trend. #iRad

@NMawlaMD @wasse_m If arterial pressure alarms = inflow, does that mean venous pressure alarms = outflow problems?

Understanding Dialysis Pressure Alarms @wasse_m

@AustinBourgeois @drcostantino1 I'll see your detachable coils and raise you a bucket load of amplatzer plugs! 🫨 💰 🔫

@drcostantino1 Haha! - but For real I think was 4, maybe 5 coils. The PenXL coils are 70cm

Bilateral varicocele embolization using detachables. Rage bait for OBL owners 🤣 #iRad

@msran124 Of course, I see it now. You tried the Chiba both from the right BCV and CFV. Pretty hardcore. I can only think of the RF wire. Failing that, I had some success with a steerable sheath - it is strong enough to steer the back end of a V18, which is probably as sharp as any needle.

@Flavius_IR The left sided access wire / balloon terminates at the end of the stent. Exits into collaterals if I try to recan from the left. I had a 65 chiba targeting the balloon from CFV.

Failed SVC recan in chronic venous congestion from SCV occlusion. TEE ✔️ Sharp recan ✔️ Still no flow… What’s your next move? 👇

@eliebalesh @TWilsonMD @farkomd @_backtable @JayMathewsMD @DrRajeshG1 @KPujdak @realarainmd @cardiojaydoc02 @SripalBangalore @IR_Doctor Conservative management should definitely be high on the options list. No good endo options that I know. Difficult discussion to have with patient.

@TWilsonMD @farkomd @_backtable @JayMathewsMD @DrRajeshG1 @KPujdak @realarainmd @cardiojaydoc02 @SripalBangalore @IR_Doctor Exemplary case of segmental arterial mediolysis (SAM). Very challenging anatomy. If sizing permits, perhaps a flow-diverting stent (ie, Pipeline) to preserve flow to the side branches.

@farkomd @_backtable @JayMathewsMD @DrRajeshG1 @KPujdak @realarainmd @cardiojaydoc02 @SripalBangalore @IR_Doctor 70M, h/o SMA aneurysm w surg repair x2 (2010/18) at tertiary care center. Back w ASx enlarging SMA aneurysm. Next step? Pt has not done well w/ Surgery. Endo option?

Places still available for budding cardiologists, radiologists or vascular surgeons on the Foundations of Endovascular Practice course 11/12/25 in Newcastle. £50 refundable deposit only (free essentially). Open to medical students or foundation doctors ukets.org

A key strategic document designed to guide and enhance IR practice in the UK @BSIR_News @TraineesBSIR @cirsesociety @RCRadiologists @pairsmedia @SIRspecialists doi.org/10.1016/j.crad…

@aksyksvsclb @jmills1955 @EBIR_Sapna @EricSecemskyMD @FadiSaab17 @FarajAlkassMD @farkomd @Flendovasc @IRKhalsa @IR_warrior_ @JayMathewsMD @JDCorlMD @JillSommerset @JoeTMarion @Jonnyboyle1 @jmsimmonsdo @JRUNMD @JVargheseMD @Indoventional @KatherineTeter @sheikhlatif14 @kmadass It is indeed. Sure, but it is sometimes/usually harder to deploy accurately. And the stakes are high.

@Flavius_IR @jmills1955 @EBIR_Sapna @EricSecemskyMD @FadiSaab17 @FarajAlkassMD @farkomd @Flendovasc @IRKhalsa @IR_warrior_ @JayMathewsMD @JDCorlMD @JillSommerset @JoeTMarion @Jonnyboyle1 @jmsimmonsdo @JRUNMD @JVargheseMD @Indoventional @KatherineTeter @sheikhlatif14 @kmadass omnilink is baloon exp. would u consider selfexp?

65 yo 👵with hypertension. here is the subclavian stenose. here are my questions:1-access site? 2-intervention? tnx in advance #cardiotwitter @PCRonline @ParisVascular @_backtable

@aksyksvsclb @jmills1955 @EBIR_Sapna @EricSecemskyMD @FadiSaab17 @FarajAlkassMD @farkomd @Flendovasc @IRKhalsa @IR_warrior_ @JayMathewsMD @JDCorlMD @JillSommerset @JoeTMarion @Jonnyboyle1 @jmsimmonsdo @JRUNMD @JVargheseMD @Indoventional @KatherineTeter @sheikhlatif14 @kmadass If you're confident about your landing, use covered balloon-mounted. If not, bare like Omnilink.

@Flavius_IR @jmills1955 @EBIR_Sapna @EricSecemskyMD @FadiSaab17 @FarajAlkassMD @farkomd @Flendovasc @IRKhalsa @IR_warrior_ @JayMathewsMD @JDCorlMD @JillSommerset @JoeTMarion @Jonnyboyle1 @jmsimmonsdo @JRUNMD @JVargheseMD @Indoventional @KatherineTeter @sheikhlatif14 @kmadass Which stent?

@aksyksvsclb @jmills1955 @EBIR_Sapna @EricSecemskyMD @FadiSaab17 @FarajAlkassMD @farkomd @Flendovasc @IRKhalsa @IR_warrior_ @JayMathewsMD @JDCorlMD @JillSommerset @JoeTMarion @Jonnyboyle1 @jmsimmonsdo @JRUNMD @JVargheseMD @Indoventional @KatherineTeter @sheikhlatif14 @kmadass 9mm is good. RVD = Reference Vessel Diameter.

@Flavius_IR @jmills1955 @EBIR_Sapna @EricSecemskyMD @FadiSaab17 @FarajAlkassMD @farkomd @Flendovasc @IRKhalsa @IR_warrior_ @JayMathewsMD @JDCorlMD @JillSommerset @JoeTMarion @Jonnyboyle1 @jmsimmonsdo @JRUNMD @JVargheseMD @Indoventional @KatherineTeter @sheikhlatif14 @kmadass Zone between VA and distal lesion is about 9 mm. What is RVD? 😇

@aksyksvsclb @jmills1955 @EBIR_Sapna @EricSecemskyMD @FadiSaab17 @FarajAlkassMD @farkomd @Flendovasc @IRKhalsa @IR_warrior_ @JayMathewsMD @JDCorlMD @JillSommerset @JoeTMarion @Jonnyboyle1 @jmsimmonsdo @JRUNMD @JVargheseMD @Indoventional @KatherineTeter @sheikhlatif14 @kmadass Assuming the indication is strong enough, the intervention is stenting, with the difficulty being the tight landing zone pre-VA. Femoral approach +/- radial to help with precise landing. Diameter is less important imo; I'd probably use RVD 6mm.

@jmills1955 @EBIR_Sapna @EricSecemskyMD @FadiSaab17 @FarajAlkassMD @farkomd @Flendovasc @Flavius_IR @IRKhalsa @IR_warrior_ @JayMathewsMD @JDCorlMD @JillSommerset @JoeTMarion @Jonnyboyle1 @jmsimmonsdo @JRUNMD @JVargheseMD @Indoventional @KatherineTeter @sheikhlatif14 @kmadass Steal syndrome.

@aksyksvsclb @EBIR_Sapna @EricSecemskyMD @FadiSaab17 @FarajAlkassMD @farkomd @Flendovasc @IRKhalsa @IR_warrior_ @JayMathewsMD @JDCorlMD @JillSommerset @jmills1955 @JoeTMarion @Jonnyboyle1 @jmsimmonsdo @JRUNMD @JVargheseMD @Indoventional @KatherineTeter @sheikhlatif14 @kmadass 1. Femoral +/- radial. 2. If you mean should I intervene, can't answer without a lot more details.

@EBIR_Sapna @EricSecemskyMD @FadiSaab17 @FarajAlkassMD @farkomd @Flendovasc @Flavius_IR @IRKhalsa @IR_warrior_ @JayMathewsMD @JDCorlMD @JillSommerset @jmills1955 @JoeTMarion @Jonnyboyle1 @jmsimmonsdo @JRUNMD @JVargheseMD @Indoventional @KatherineTeter @sheikhlatif14 @kmadass

The countdown to #BSIR2025 has officially begun! Dr Matthew Gibson, Chair of this year’s Scientific Programme Committee, welcomes the IR community to what promises to be an outstanding three days in Liverpool: “Every procedure, every decision we make, hinges on our ability to safeguard those in our care.” This year’s programme is built for all stages of the IR journey — from medical students to consultants, and radiographers to nurses. With a clear focus on patient safety, emergency IR, and chronic limb-threatening ischaemia, the agenda is practical, inclusive, and future-focused. Expect: → Small group masterclasses → Leading experts in seminar-style sessions → The latest insights from our industry partners → Plenty of opportunity to connect, share, and grow 📅 6–8 November 2025 📍 ACC Liverpool 🎟️ Book your place now: bsirmeeting.org #BSIR2025 #InterventionalRadiology #IRCommunity #MedicalConference #PatientSafety #LiverpoolEvents youtu.be/oHuF9OigA_Y

@karananandpara #2 is most impressive. Do you have more details on how it happened and/or got fixed, if it got fixed?

Case 142: Displaced lines, tubes, ports . #1: Dialysis Cath tip in left BCV #2: Tunneled Dialysis Cath tip in pericardium #3: Dialysis Cath tip in RV #4: Chemo-Port Tip cut short in right BCV . #irad #medx #medtwitter #cardiotwitter #medX #radiotwitter #virad #nephrotwitter #nephrotwitter @SIRspecialists @SIR_ECS @SIRRFS @cirsesociety @ETF_IRtrainees @_backtable @_backtable @VascularForum