September 5-9 | Copenhagen, Denmark
September 5-9 | Copenhagen, Denmark
September 5-9 | Copenhagen, Denmark
September 5-9 | Copenhagen, Denmark
September 5-9 | Copenhagen, Denmark
Dr. Miltiadis Krokidis
Speaker bio
Interventional Radiology offers a minimally invasive solution for a large spectrum of pathologies and plays a cardinal role in the management of large numbers of patients. From patients with peripheral arterial disease and venous problems to patients with cancer and renal failure IRs everyday offer a wide number of valuable solutions. The evolution of IR in the last decade is that of an autonomous clinical service, where patients that undergo IR procedures are reviewed before and after in an IR clinic. Therefore, most procedures are performed as elective cases as scheduled by the performing IR and admission is arranged exclusively by the IR team without depending on other teams in the hospital.
The IR team will look after the patients after the procedure and will discharge the patient with instructions. Radiology day units have been developed in most of IR departments and the number of procedures that were offered as day-cases increased, initially from peripheral angioplasties and biopsies, to radioembolization and lung ablation. As the spectrum of disease that is treated as day case increases patient selection becomes of paramount importance.
A good general status is usually required, with autonomous mobility and mental capacity. This assessment should be performed at the IR clinic when the discussion for the procedure takes place. Factors like the need for pre- or post-hydration in case of deranged renal function, the need for intravenous antibiotics pre- or post-procedure, anticoagulation management or the risk of potential pneumothorax need to be assessed, discussed and evaluated and a specific plan needs to be in place.
A patient after lung biopsy or lung ablation may be discharged the same day even with a small (<10%) pneumothorax however a chest X-ray the next day is recommended to assess the evolution. In case for example that minor haemoptysis is expected after discharge, the patient needs to be aware, and the managing IR or the IR team should be available to manage that when the patient asks for advice.
In case of any potential complications i.e. the patient drops the blood pressure during stay then the team should be alert to perform a CT scan and potentially an embolization procedure, therefore whoever is managing these patients should be in position to offer the whole spectrum of IR procedures.
Pain management is also crucial for patients that return home after a day procedure. Most procedures will be performed under local anaesthesia with or without conscious sedation rather than general anaesthesia. Typically, short acting local anaesthetics such as Lidocaine are used to control access-site pain, while moderate sedation with agents like Midazolam and Fentanyl provide anxiolysis and additional analgesia, allowing patients to remain responsive but comfortable throughout the procedure. A multimodal approach to analgesia may also be considered, combining these intra-procedural strategies with regular post-procedural medications such as Paracetamol and non-steroidal anti-inflammatory drugs like Ibuprofen to reduce opioid requirements and improve recovery. For example if a patient with metastatic liver undergoes a liver ablation of a single 2 cm lesion with microwave under conscious sedation and has an uneventful recovery at the radiology day unit for 8 hours- time where potential arterial post procedure bleeding would have been manifested- may be discharged by the IR team with instructions for antibiotic coverage (co-amoxiclav 1 gr two times per day) for 6 days and analgesia (paracetamol 1 gr two times per day) for 3 days. Post embolization i.e. fibroid or prostatic embolization analgesia with COX-2 inhibitors (Celecoxib 100 mg two times a day) may be considered to limit the “rebound-pain” once the peri-procedural analgesia wears out.
Prior to discharge the IR team should:
There is no doubt that radiology day units have offered a flexible platform for both IRs and health systems to manage a significant number of patients without the need to occupy a hospital bed. IRs who are the main stakeholders need to make appropriate patient selection offer adequate pain control discharge patients under specific protocols.
Miltiadis Krokidis, MD, is an Associate Professor of Interventional Radiology at Areteion Hospital ath the University of Athens with a distinguished international career including consultant roles at Cambridge University Hospitals and Inselspital Bern. A Fellow of CIRSE and holder of both EBIR and EBIR-ES certifications, he currently serves as the Deputy Chairperson of the IASIOS Committee and is a key member of the Scientific Program and Social Media committees. Beyond his clinical leadership, he is a prolific academic and Associate Editor for CVIR. He has authored over 120 peer-reviewed articles, edited a definitive IR textbook, and delivered more than 100 invited lectures worldwide. His work focuses on the full spectrum of IR procedures and the development of Standard Operating Procedures (SOPs) to advance global clinical standards.
