@IRtmke

@MCW_VIR ‘22 |@MCWRadiology ESIR ‘21 | @UICCOM ‘16 / worse at twitter than @gaurav_gadodia / fmr @SIRRFS Clin Ed Chair / #IRad / Views own

 Milwaukee, WI
Joined November 2015
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Elderly pt, previously ambulatory, admitted w/ intractable pain following a fall. Bedridden, immobilized, requiring IV narcotics. Unable to work with PT/OT. +SIJ provocative tests. Complex sacral fx, spanning Denis zones 1-3 out to SI joints, with areas of offset and impaction.
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Concern for integrity & cement containment w/ routine sacroplasty. Posterior pelvic stabilization w/ perc screw and cement. Bilateral S1 approach due to transitional segment anatomy. S2 trans-iliac trans-sacral. POD1 pain 10/10 -> 4/10. Up working w/ PT/OT. D/C to rehab POD3
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Recent onset nightly rest pain w/o tissue loss or discoloration. Focal calcific popliteal occlusion. 014 crossing through tiny channel, 2 mm PTA, 5 mm shockwave, 6 mm PTA/DCB at nominal. Sx resolved. Tibial/pedal stenoses not touched in absence of wound. Cont followup
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Tandem functional calcific occlusions at adductor canal. Lithotripsy is a game changer here. But meticulous intraluminal crossing is key to making this a worthwhile IVL + low pressure PTA/DCB instead of a supera
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Recurrent high CFA PsA s/p TAVR despite thrombin injection by other service. Nice demo of internal iliac collateral flow potential to lower extremity in the setting of external iliac/common femoral occlusion, in this case balloon tamponade at neck during perc thrombin injection.
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As much as I love curved needle, sometimes you have to be direct. Trans-SI approach for biopsy & ablation of solitary metastasis of central S2. @bkeyMD @ChengaziMD @iRadRock @gaurav_gadodia @SIRRFS
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~90 yr old pt admitted s/p fall. Previously ambulatory -> bedridden 10/10 pain & unable to participate w/ PT/OT. Acute sacral fx extending up along S1 pedicle screws. Long axis + curved needle sacroplasty FTW! Up walking POD 1, pain 10 -> 3
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Happy to announce our Cholangioscopy/lithotripsy course on 12-13th July. Hands-on live-animal workshop, limited seats!
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Someone out in the OSH endo-verse needs to hear: when tx’ing calcific occlusion, stent *through* it, not right into it. Recurrent short distance claudication now c/b forefoot rest pain. Native SFA thrombus, Ca+ occlusion, & in-stent stenoses w/ single vessel AT.
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Lithotripsy Ca+, athero-thrombectomy (native and in-stent), followed by stent revision and some final PTA/DCB. Nice warm 🦶 to enjoy the weekend. F/u in a few weeks. Prior multi vessel CABG with saphenous, hoping to keep endo durable.
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Call case for Massive PE with intitial HypoT and +Trop, lactate 3.3 with initial PESI score of 159. RH strain on Echo. BP improved with Hep GtT in ED. Straight to IR for thrombectomy. 45 minutes. Life saved. @ReQuadIR @InariMedical
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Neuro/#MSKIR crossover. Young healthy pt. Hx of daily exercise w/ neck flexion. Progressive disabling symptoms of intracranial hypotension, 4-8 weeks. Multiple ED visits. CT myelogram confirms high thoracic CSF leak at level of sharp calcified posterior disc-osteophyte margin
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Given surgical risks/morbidity, ventral epidural fibrin + blood patch performed at level of dural injury. Leak resolved, symptoms improved. Recovery complicated by rebound intracranial hypertension, medically managed. CSF leaks are difficult to dx & tx. Likely under-dx – at Milwaukee, WI
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Apparently, •22 Clinical Studies •2 RCTs •1 Prosp Single Arm Control Trail •7 Syst Reviews •4 Society Guideline Recs •5 Book Chs •1 Non-Industry Sponsored SAC Trial and 4 Single Arm Trials Isn't enough data for United Healthcare to cover BVNA 🙄 radiologybusiness.com/topics…

Radiology groups slam UnitedHealthcare decision they say was inspired by ‘science-harvesting...

UHC has labeled an IR service docs have been delivering for 9 years as “unproven and not medically necessary due to insufficient evidence of efficacy."

radiologybusiness.com
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#itsnotthedoctors – at Minneapolis, MN
Beth Joyner Waldron@BethWaldron5 Mar 2024
Top 5 execs at United Healthcare responsible for the strategic direction & overall performance of the business earn a combined $75 million. Clearly, the notion that people are paid what they're worth is pure myth when UHC patients lack medications & HCPs aren’t getting paid.
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Saw rise in consults for recurrent VCF in pts who have undergone prior intervention on same level. A lot of ink spilled about technique on #IRTwitter, had two cases in particular that keep me thinking about cement distribution/density & bone health – at Milwaukee, WI
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Second case, elderly pt. Admitted & unable to wean from IV narcotics. Had prior work done to say the least, L2 cement atleast 10 years old. Acute re-fx thoroughly around cement, +pedicles, endplate, & posterior wall buckling, all xray occult. – at Milwaukee, WI
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Interesting to see the mix of interventions/techniques. And interesting that L2 re-fractured before the untreated L5 ever fractured – at Milwaukee, WI
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Shared because there’s a tendency to ascribe edema in previously treated levels on MRI as “healing” even when Hx is new/worsening back pain. Assess cortices carefully, changes are subtle in partially supported re-fx. Seeing edema without cement in sagittal slice is sus – at Milwaukee, WI
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Little video of wimpy cement fill being wimpy – at Milwaukee, WI
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