Interventional radiology in gynecology and obstetric practice: Safety issues

Abstract

Interventional radiology is continuing to reshape current practice in many specialties of clinical care and the fields of gynecology and obstetrics are no exception. Imaging skills, clinical knowledge as well as vascular and non-vascular interventional technical ability, are essential to practice interventional radiology effectively. Patient safety is of paramount importance in interventional radiology as in all branches of medicine. Potential failures occur throughout successful procedures and are attributed to a spectrum of errors, including equipment unavailability, planning errors, and communication errors. These are mainly preventable by improved preprocedural planning and teamwork. Of all the targeted and effective actions that can be undertaken to reduce adverse events, the use of safety checklists might have a prominent role. The advantage of a safety checklist for interventional radiology is that it guarantees that human error in terms of forgetting key steps in patient preparation, intraprocedural care, and postoperative care are not forgotten.

Figure 1

A 37-year-old lady with previous intracavitary maneuvers (1 myoma ablation and 2 curettages) causing uterine arteriovenous malformations (AVM). Contrast-enhanced magnetic resonance in coronal plane shows a focused irregular enhancement of the uterine wall, partially involving the uterine cavity, corresponding to an AVM (A, white dotted circle). Superselective digital subtraction angiography (DSA) of left uterine artery showing multiple tortuous and ectasic vessels with early venous wash-out (B, white dotted circle), angiographic finding of AVM. Superselective DSA of right uterine artery shows multiple tortuous and ectasic vessels with early venous wash-out (C, white dotted circle), corresponding to right refurnishment of the AVM; embolization cast of Onyx18 of the left side (C, black arrow). Right hypogastric DSA showing exclusion of the AVM from the blood flow after bilateral uterine artery embolization; the embolization casts are indicated by black arrows (D).

Figure 2

A 44-year-old lady with uterine myomas. Superselective digital subtraction angiography (DSA) of left uterine artery showing an irregular round-shaped vascularization (A, dotted black circle), corresponding to the dominant myoma of the left uterine portion. Superselective DSA of right uterine artery showing a similar irregular round-shaped vascularization (B, dotted black circle), corresponding to the dominant myoma of the right uterine portion; the cast of the left side embolization is also evident (B, dotted gray circle). Embolization was performed with 500-700 μm microparticles.

Figure 3

A 31-year-old lady with pelvic congestion syndrome causing pelvic pain for 1 year, treated by endovascular embolization. Fluoroscopy shows catheterism of an insufficient and ectasic left ovarian vein with parauterine reflux (A); sclerosant injection and coils embolization of the left ovarian vein (B). Controlateral digital subtraction angiography (DSA) demonstrating insufficiency and massive dilation of the right ovarian vein with marked parauterine reflux (C) that was similarly occluded with sclerosant coils (D).

Figure 4

Example of planimetry related to an IR department. Not every room is represented in this schematic drawing, but it does show how some modalities and several suites can be planned close together, bringing benefits in patient care, efficient use of space by sharing some of the supporting rooms, good clinical communication and expertise sharing. Pt, patient; SA, storage area; Lau, laundry; US, ultrasound.

Figure 5

Operating theater with C-arm positioned for interventional procedures; the beam source is positioned below the patient and should be at maximum distance from the patient (white dotted arrow).

Figure 6

Angiosuite with leaded x-ray protections (white arrow: low protection with leaded curtain; gray arrows: high protection with leaded curtain and leaded glass).

Figure 7

Wearable x-ray protections (white arrow: leaded gown; gray arrow: leaded collar; black arrow: leaded glasses; black dotted arrow: leaded cap).