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Background Procedures performed after-hours have been associated with worse outcomes in several procedural specialties. Data examining the relationship between procedure timing and adverse event severity in interventional radiology remain limited. This study retrospectively evaluated adverse events reviewed at interventional radiology morbidity and mortality conferences to assess whether procedure timing was associated with differences in adverse event severity and quality-of-care assessment. Results A total of 547 adverse events occurring across four affiliated hospital sites were included. The cohort comprised 341 males and 206 females with a mean age of 56.2 years. Vascular procedures accounted for 369 events (67.5%), and non-vascular procedures accounted for 178 events (32.5%). Most adverse events occurred during weekday daytime hours ( n  = 459, 83.9%), followed by weekday after-hours ( n  = 50, 9.1%) and weekend periods ( n  = 38, 6.9%). Compared with weekday daytime procedures, a greater proportion of adverse events resulting in death occurred during weekday after-hours and on weekends, as reflected by a higher proportion of Society of Interventional Radiology class F events and Harm Score 9 outcomes ( p  < 0.001). In contrast, no significant difference in Quality Control System scores was observed across procedure timing categories ( p  = 0.73). Conclusions Among adverse events reviewed at interventional radiology morbidity and mortality conferences, procedures performed during weekday after-hours and weekend periods were associated with greater adverse event severity, while quality-of-care assessments did not differ by procedure timing. These findings describe patterns within morbidity and mortality-reviewed complications and do not estimate complication rates or population-level risk by procedure timing. The absence of variation in Quality Control System scores supports the hypothesis that observed differences in severity may reflect patient acuity and procedural urgency rather than differences in procedural quality.

Purpose The Protrieve Sheath (Inari Medical; Irvine, CA) is designed for embolic protection during venous thrombectomy. This report describes experience with its use. Materials and methods Between November 2022 and December 2023 (13 months), seventeen patients, including nine (52.9%) females and eight (47.1%) males (mean age 58.8 ± 13.3 years, range 37–81 years), underwent deep venous thrombectomy following the Protrieve Sheath placement for embolic protection. Gender, age, presenting symptoms, procedural indications, obstructed venous segments, the Protrieve Sheath access and deployment sites, thrombectomy devices utilized, need for stent reconstruction, technical success, clinical success, adverse events (the Protrieve Sheath maldeployment or clinically significant embolic events), removed thrombi analyses, and mortality were recorded. Technical success was defined as successful deployment of the Protrieve Sheath funnel central to the thrombectomy site. Clinical success was defined as improvement in presenting venous occlusive symptoms without procedure-related venous thromboembolism. Results The most common presenting symptom was extremity swelling ( n  = 15; 88.2%). Nine (52.9%) patients had malignant and eight (47.1%) had benign etiologies of venous obstruction. Obstructed venous segments included the inferior vena cava (IVC) and lower extremity ( n  = 9; 52.9%), isolated lower extremity ( n  = 4; 23.5%), isolated IVC ( n  = 2; 11.8%), thoracic central veins and superior vena cava ( n  = 1; 5.9%), and isolated thoracic central vein ( n  = 1; 5.9%). The Protrieve Sheath access sites included the right internal jugular vein ( n  = 15; 88.2%) for IVC and lower extremity obstructions and the right common femoral vein ( n  = 2; 11.8%) for thoracic central vein and superior vena cava obstructions. The Protrieve sheath funnel deployment locations included intrahepatic IVC in 13 patients ( n  = 13; 76.5%), suprarenal IVC in two ( n  = 2; 11.8%), and inferior cavoatrial junction in two ( n  = 2; 11.8%). Thrombectomy devices used included the ClotTriever System (Inari Medical) ( n  = 15; 88.2%), the InThrill Thrombectomy System (Inari Medical) ( n  = 4; 23.5%), the FlowTriever System (Inari Medical) ( n  = 2; 11.8%), the Lightning Flash 16 Aspiration System (Penumbra; Salt Lake City, UT) ( n  = 2; 11.8%), the Cleaner Rotational Thrombectomy System (Argon; Plano, TX) ( n  = 1; 5.9%), and the RevCore Thrombectomy System (Inari Medical) ( n  = 1; 5.9%). Ten (58.8%) patients required stent reconstruction following thrombectomy. Technical success was achieved in all patients. Clinical success was achieved in 16 (94.1%) patients. No immediate adverse events, including the Protrieve Sheath maldeployment or clinically significant embolic events, occurred. Conclusion Use of the Protrieve Sheath during large-bore venous mechanical thrombectomy resulted in favorable technical and clinical outcomes without device-related adverse events or clinically significant thromboembolic events.

[...]although the reporting of IVC filter retrievability and manufacturer model in diagnostic radiology remains limited, it represents an opportunity for standardization and clinical impact. Authors’ contributions All authors contributed to all aspects of the study, including study design, data collection, analysis, and manuscript preparation. Declarations Ethics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

In particular, stent migration and stent fracture may cause life-threatening venous or cardiopulmonary injury [1]. [...]solitary stents at the IVC and HV confluence may lead to recurrent HVOO through mechanical obstruction and endothelial hyperplasia [1]. Patient demographics Subject Number Age, Sex Liver Disease Etiology Liver Transplant Date, anastomosis type Interval to intervention Prior intervention Indication for procedure Diagnostic imaging 1 69, M Alcoholic Cirrhosis and HCC 2004, piggyback 1 month no Ascites, LFTs US w doppler 2 52, M HCV and Alcoholic Cirrhosis 2006, piggyback 10 months Angioplasty of IVC and HV Ascites and LFTs US w doppler 3 53, F HCV 2009, piggyback 1.5 months no Abnormal LFTs US w doppler 4 58, M HCV and Alcoholic Cirrhosis 2008, piggyback 13 months HV angioplasty Ascites and LFTs US w doppler 5 65, M HCV and Alcoholic Cirrhosis 1994, piggyback 265 months no Ascites CTAP w contrast 6 48, M HCV 2007, piggyback 145 months IVC angioplasty on 4 separate occasions Ascites US w doppler 7 64, F Alcoholic Cirrhosis 2017, piggyback 25 months no Ascites US w doppler HCV Hepatitis C Virus, HBV Hepatitis B Virus, HCC Hepatocellular Carcinoma, LFTs Liver Function Tests Table 2. Clinical Outcomes Subject Number Clinical success, when (days post procedure) Postprocedural Complications Repeat intervention Stent patent at last f/u imaging (days), stent lack of migration (days) Final Clinical Outcome 1 Yes, 22 No no 56 (patient died), 51 Improved ascites control, pt died of complication of graft rejection 2 No: required long-term denver-shunt for ascites control, N/A No Angioplasty and additional IVC stent placed 2 months after procedure for stenosis in the IVC at the superior border of the first IVC stent. [...]the interlocking design provides mutual stent stabilization, reducing risk of stent migration, which is a serious complication that may require surgical intervention [1].

Background Endovascular stenting is widely accepted as the standard treatment for central venous obstruction syndromes such as superior vena cava (SVC) syndrome due to its demonstrated clinical efficacy and improved patient outcomes. However, its application in axillosubclavian vein thrombosis (ASVT) has been limited due to concerns about stent compression within the thoracic outlet. This report aims to evaluate the feasibility and safety of the off-label use of dedicated venous stents—engineered with enhanced mechanical features—as an alternative endovascular approach for the treatment of ASVT. Methods Thirty-eight patients (43 affected limbs) with symptomatic ASVT and no prior treatment or surgical decompression underwent endovascular placement of dedicated venous stents across the thoracic outlet with Abre Venous Stents (Medtronic, Dublin, Ireland), Venovo Venous Stents (BD, Franklin Lakes, NJ, USA), or Vici Venous Stents (Boston Scientific, Marlborough, MA, USA). Stents were extended peripherally to the subclavian or axillary veins and centrally to the brachiocephalic vein or SVC. Technical success was defined as successful stent deployment across the costoclavicular space, and clinical success as symptomatic improvement. Results Stent placement was technically successful in all 43 limbs (100%), with clinical improvement observed in 97.4% of patients. The one patient without clinical improvement experienced early thrombosis of the stent, requiring mechanical thrombectomy and additional stenting. Follow-up CT venography at a mean of 301.3 days demonstrated high primary stent patency rates (81.4%), with stent crushing observed in only 7.0% of limbs and no instances of stent fracture. Adverse events were limited, including two access site hematomas and one hypotensive episode, all of which resolved without evidence of long-term complications. Conclusions Our findings suggest that stenting across the thoracic outlet for the treatment of ASVT may be a viable option with the use of novel dedicated venous stents, potentially expanding treatment strategies for TCVO.

Background There have been several analyses conducted demonstrating a sharp decrease in general physician fulfillment and satisfaction. Other studies have demonstrated that burnout, anxiety, and moral injury are prevalent among interventional radiologists specifically, however there is a paucity of literature examining professional fulfillment within the profession. The purpose of this study was to characterize professional fulfillment through job, career, and specialty satisfaction scores among interventional radiologists using a validated assessment tool. Results There were 106 respondents included in the analysis: 97 (91.5%) practicing interventional radiologists and 9 (8.5%) interventional radiology trainees, including 87 (82.1%) males and 19 (17.9%) females. Respondents included those in academic (40; 37.7%), private practice (46; 43.4%), and hybrid/other settings (20; 18.9%), as well as at various lengths of practice. The mean job satisfaction score was 3.48, with 38 (35.8%) of respondents expressing a mean score of ≥ 4, which has been established as being “satisfied”. The mean career satisfaction score was 3.40, with 38 (35.8%) of respondents reporting a mean score of ≥ 4. The mean global specialty satisfaction was 3.63 with 53 (50.0%) of respondents reporting a mean score of ≥ 4. Conclusions Professional fulfillment is low among interventional radiologists, with half expressing global specialty satisfaction and with minority percentages signaling job and career satisfaction. Patient interaction and work-life balance were identified as significant factors positively affecting professional fulfillment.

Purpose To evaluate access site adverse events following ClotTriever-mediated large-bore mechanical thrombectomy via small upper extremity deep veins (< 6-mm). Materials and methods Twenty patients, including 24 upper extremity venous access sites, underwent ClotTriever-mediated large-bore thrombectomy of the upper extremity and thoracic central veins for symptomatic deep vein obstruction unresponsive to anticoagulation. Patients without follow-up venous duplex examinations ( n  = 3) were excluded. Patients who had > 6-mm diameter veins accessed ( n  = 3) were excluded. Temporary purse-string sutures and manual pressure were used for access site hemostasis in all patients. Vein access site and diameter, technical success (defined as placement of the 13.5-French ClotTriever sheath followed by thrombectomy), and early (< 30-days) and late (> 30-days) access site-related adverse events (according to the Adverse Event Classification by the Society of Interventional Radiology criteria) were recorded. Results Fourteen patients (8 males, 6 females; mean age 51.7 ± 13.6 years) comprising 16 upper extremity venous access sites were included in this study. Access sites included: right brachial ( n  = 7), left brachial ( n  = 5), and bilateral brachial ( n  = 2) veins. The mean access site diameter was 4.3-mm ± 0.67-mm. Technical success was achieved via all access sites. Six (42.9%) patients underwent stent reconstruction following thrombectomy through the same accesses. After the procedure, all purse-string sutures were removed within 24 h. Three (21.4%) patients experienced small access site hematomas that did not require transfusion, intervention, or prolonged hospitalization. Initial follow-up venous duplex ultrasounds were performed at 29.3 ± 21.7 days following intervention. The mean follow-up interval to the second and third venous duplex ultrasounds were 124.3 ± 64-days and 225.1 ± 80.1 days, respectively. One (7.1%) patient developed right arm swelling six days after the procedure and was found to have thrombosis of the previously accessed right brachial vein. No other clinically or sonographically significant access site adverse events were observed. Conclusion ClotTriever-mediated large-bore thrombectomy via small upper extremity veins is safe with minimal access site adverse events.

Purpose Endovascular recanalization and stent reconstruction constitute an effective and safe treatment option for symptomatic thoracic central venous obstruction (TCVO). Rare life-threatening adverse events are possible during or immediately following the procedure, with the most feared one being hemopericardium with cardiac tamponade. A technique to improve efficiency in detection and treatment of cardiac tamponade is described. Materials and methods An institutional protocol was established for intraprocedural transthoracic echocardiographic monitoring during the TCVO recanalization procedures. The lower chest and upper abdomen were prepared within the sterile field. A separate stand was set up with unopened supplies needed for pericardial drain placement. Intermittent echocardiographic monitoring was performed throughout the TCVO procedure using a dedicated curvilinear probe prepared on the field. If indicated, an image guided pericardial drain was placed expeditiously. Results Four cases of cardiac tamponade were encountered during or immediately post-procedure. All cases demonstrated technically successful and prompt pericardial drain placement with immediate reversal of the tamponade physiology. Conclusion Echocardiographic monitoring during TCVO reconstruction by interventional radiologists is a useful technique which may aid in early diagnosis and management of cardiac tamponade.