RESUMEN
Venous compressive disorders are a heterogenous group of vascular syndromes characterized by extrinsic venous compression that can lead to complications of venous hypertension or venous thrombosis. Endovascular damage secondary to deep venous thrombosis (DVT) can result in post-thrombotic syndrome (PTS), a potentially debilitating condition that can be associated with significant morbidity in the pediatric population. Here we discuss 4 venous compressive disorders: iliac vein compression (May-Thurner syndrome [MTS]); subclavian vein compression at the venous thoracic inlet (Paget-Schroetter syndrome); left renal vein compression (nutcracker syndrome); and popliteal vein compression (popliteal entrapment syndrome) with a focus on clinical evaluation and diagnostic methods. Where endovascular therapy is appropriate, specific procedural considerations including procedure indications, equipment, procedural steps, technical challenges, complications, clinical follow-up and expected outcomes are discussed.
Asunto(s)
Procedimientos Endovasculares , Síndrome de May-Thurner , Humanos , Síndrome de May-Thurner/terapia , Síndrome de May-Thurner/diagnóstico por imagen , Síndrome de May-Thurner/fisiopatología , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Resultado del Tratamiento , Flebografía , Síndrome de Cascanueces Renal/diagnóstico por imagen , Síndrome de Cascanueces Renal/fisiopatología , Síndrome de Cascanueces Renal/terapia , Valor Predictivo de las Pruebas , Vena Poplítea/diagnóstico por imagen , Vena Poplítea/fisiopatología , Factores de Riesgo , Vena Subclavia/diagnóstico por imagen , Vena Subclavia/fisiopatología , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/fisiopatologíaRESUMEN
OBJECTIVE: The training experience in interventional radiology (IR) residency programs varies widely across the country. The introduction of an IR training pathway has provided the impetus for the specialty to better define outstanding IR education and for programs to rethink how their curricula prepare IR trainees for real-world practice. Although ACGME competencies define several training components that are necessary for independent practice, few quantitative or qualitative studies have explored current perceptions on what constitutes optimal IR training. Our goal was to qualitatively explore program training features deemed most important to adequately prepare IR physicians for practice and assess whether there were differences in perception between academic and nonacademic practices. METHODS: Semistructured interviews were conducted with 71 IR attending physicians, trainees, and support staff across the United States. All interviews were performed over the telephone by a single researcher for consistency and systematically coded by two independent coders for common themes. Frequency and prevalence of themes and facilitating features were analyzed. RESULTS: The most frequently perceived facilitating features included longitudinal patient care experience, practice-building education, interspecialty collaboration exposure, broad case mix, clinical decision-making exposure, diagnostic radiology training, procedural skills training, and graduated autonomy. Comparing nonacademic versus academic practice settings, significantly more nonacademic IR attending physicians expressed practice-building education (prevalence 72% versus 42%, frequency 2.2 versus 0.7, P < .01) as an important training experience. DISCUSSION: An understanding of perceived facilitating features for optimal IR trainee preparation, including potentially different needs between academic and nonacademic practices, can help programs prepare their trainees for a successful transition into practice.