Complications in Non-vascular Interventional Therapy and Interventional Oncology: Case-based Solutions E-Book

• Herausgeber: Thieme
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 202

Veröffentlichungsjahr: 2019

Beschreibung

Learn to avoid and manage complications from non-vascular interventional and interventional oncological procedures

The range of non-vascular procedures that can be performed in interventional imaging is vast and includes management of a wide range of conditions, such as treatment of kidney stones, obtaining diagnostic biopsies in suspected cancers, bile duct occlusions, compression fractures, drainage of abscesses, collection of fluids, etc. In particular, various cancers often lend themselves well to local tumor destruction with interventional techniques, while holding morbidity and mortality to a minimum.

This compendium presents 45 cases in detail to provide a thorough review of potential complications that may occur during non-vascular interventional radiology and interventional oncological procedures. Each case also includes a list of take-home messages discussing vital prevention strategies for each problem.

Key Features:

• Content presented in case-based format to help the reader benefit from the real-life experiences of the authors and motivate them to take part in identifying the problem and finding a solution to a specific situation
• Solid coverage of characteristic complications of special technologies, such as thermal ablation and percutaneous CT-guided interstitial high-dose brachytherapy
• A wealth of information and advice for optimizing patient safety before, during, and after interventional therapy
• Take-home messages at the end of each case providing vital prevention strategies

Complications in Non-vascular Interventional Therapy and Interventional Oncology: Case-based Solutions is an invaluable sourcebook for radiology residents and fellows, experienced interventional radiologists, and all physicians actively performing non-vascular and oncological interventions. This book discusses methods to both avoid and manage complications, t

Leseprobe

Complications in Non-vascular Interventional Therapy and Interventional Oncology: Cased-based Solutions

Stefan Mueller-Huelsbeck, MD, PhD, EBIR, FICA, FSIR

Professor of Radiology, Board Certified NeuroradiologistDepartment of Diagnostic and Interventional Radiology and NeuroradiologyDeaconess HospitalFlensburg, Germany

Thomas Jahnke, MD, PhD, EBIR, FICA, FSIR

Professor of RadiologyDepartment of Diagnostic and Interventional Radiology/Nuclear MedicineFriedrich-Ebert-HospitalNeumuenster, Germany

With contributions from

Adam Hatzidakis, Afshin Gangi, Alessandro Lunardi, Antonio Basile, Athanasios Pantos, Attila Kovács, Constantinos T. Sofocleous, Dimitrios Filippiadis, Dimitrios Samonakis, Douglas Silin, Frédéric Deschamps, Garnon Julien, Georgia Tsoumakidou, Ieva Kurilova, Ioannis Dedes, Irvin Rexha, Jean Caudrelier, Karin Steinke, Koch Guillaume, Lambros Tselikas, Laura Crocetti, Milena Miszczuk, Miltiadis E. Krokidis, Nariman Nezami, Nikolaos Galanakis, Piercarlo Rossi, Rajasekhara R. Ayyagari, Roberto Cioni, Roberto Luigi Cazzato, Samuel Lewis Rice, Thierry de Baere, Thomas K. Heimberger, Yasuaki Arai

251 illustrations

ThiemeStuttgart • New York • Delhi • Rio de Janeiro

Library of Congress Cataloging-in-Publication Data

Names: Mueller-Huelsbeck, Stefan, author. | Jahnke, Thomas, author.

Title: Complications in non-vascular interventional therapy and interventional oncology : case-based solutions / Stefan Mueller-Huelsbeck, Thomas Jahnke; with contributions from Adam Hatzidakis [and others].

Description: Stuttgart; New York : Thieme, [2019] | Includes bibliographical references and index. | Identifiers: LCCN 2019019129 (print) | LCCN 2019020383 (ebook) | ISBN 9783132413047 () | ISBN 9783132412873 (hardback) | ISBN 9783132413047 (eISBN)

Subjects: | MESH: Radiography, Interventional–adverse effects | Biopsy–adverse effects | Ablation Techniques– adverse effects | Chemoembolization, Therapeutic–adverse effects | Equipment Failure | Case Reports

Classification: LCC RD35 (ebook) | LCC RD35 (print) | NLM WN 202 | DDC 616.07/58–dc23

LC record available at https://lccn.loc.gov/2019019129

© 2019 by Georg Thieme Verlag KG

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ISBN 978-3-13-241287-3

Also available as an e-book:eISBN 978-3-13-241304-7

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Dedicated to my wife Anke and our children Albert, Viktor, Richard and Felix.

Stefan Mueller-Huelsbeck

Dedicated to my wife Anne and our children Noé and Eliot.

Thomas Jahnke

Contents

Foreword

Preface

Contributors

1 Introduction

2 Minor and Major Complications

2.1 Definition and Reporting System of Complications

2.2 Avoiding Complications

2.2.1 Patient Safety

2.2.2 Patient Safety Checklist

2.2.3 Periprocedural Documentation

2.3 General Complications Related to Non-vascular and Oncologic Procedures

2.3.1 Impaired Renal Function

2.4 Known Allergic Reactions to Contrast Material

2.5 Radiation Exposure

2.6 Infection

2.7 Management of Complications

2.7.1 Arterial Hemorrhage

2.7.2 Preventing Arterial Hemorrhage

2.7.3 Device Malfunction

2.7.4 Preventing Device Malfunction

3 Case-Based Procedure-Related Complications

3.1 Bleeding

3.1.1 Bleeding after Percutaneous Biopsy of Liver Tumor

3.1.2 Hemothorax during Electroporation for Hepatocellular Carcinoma Treatment

3.1.3 Cervical Hematoma after Thyroid Fine Needle Aspiration Biopsy

3.1.4 Hepatic Intraparenchymal Hemorrhage after CT-Guided Liver Biopsy

3.1.5 Hemodynamic Instability, Presumed to be Related to Worsening Retroperitoneal Hemorrhage during and after Cryoablation for Renal Tumor Treatment

3.1.6 Mediastinal Hemorrhage and Hemothorax after Anterior Mediastinal Puncture

3.1.7 Hemoptysis after Percutaneous Lung Biopsy

3.1.8 Delayed Bleeding after Biliary Drainage

3.1.9 Bleeding during Diagnostic CT-Guided Liver Puncture

3.1.10 Bleeding after Radiofrequency Ablation for Hepatocellular Carcinoma Treatment

3.1.11 Massive Pleural Hemorrhage after Lung Radiofrequency Ablation

3.1.12 Delayed Bleeding after Microwave Ablation for a Recurrent Colorectal Liver Metastasis

3.2 Cement Extravasation

3.2.1 Pulmonary Cement Embolization after Vertebroplasty for Lumbar Fracture Treatment

3.2.2 Endplate Cement Extravasation after Balloon Kyphoplasty for Treatment of Osteoporotic Fracture

3.2.3 Intra-articular Cement Leakage after Bone Augmentation in the Peripheral Skeleton

3.3 Device Failure

3.3.1 Two Cases of Short Antenna during Microwave Ablation for Treatment of Lung Nodules

3.3.2 Antenna Fracture during Microwave Ablation for Treatment of Non-Small-Cell Lung Cancer

3.3.3 Thermal Ablation: Cutting Off the Leg of a Radiofrequency Ablation Device during a Simultaneous Biopsy

3.4 Infection

3.4.1 Hepatic Abscess after Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

3.4.2 Liver Abscess after Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

3.4.3 Injury of the Liver and Biliary System after Drug Eluting Beads Transcatheter Intra-arterial Chemoembolization

3.5 Non-vascular Miscellaneous Cases

3.5.1 Renal Defect after Cryoablation of Renal Tumor

3.5.2 A Bronchial Fistula Following Percutaneous Lung Microwave Ablation

3.5.3 Lethal Hepatocellular Tumor Rupture after Incomplete Chemoembolization: What Went Wrong?

3.5.4 Interstitial Pneumonitis after Microwave Ablation for Metastatic Lesion Treatment

3.5.5 Insufficiency Fracture Following Bone Cryoablation

3.5.6 Postablation Biloma with Further Sequelae after Percutaneous Microwave Ablation for Treatment of Recurrent Metastasis

3.5.7 Hip Joint Destruction following Radiofrequency Ablation and Cementoplasty of an Adjacent Bone Metastasis

3.5.8 Calyceal Leakage after Renal Biopsy

3.5.9 Hemopericardium Following Malplacement of a Radiofrequency Ablation Electrode during Thermal Ablation of the Liver—A Potentially Fatal Complication

3.5.10 Infection of the Ablation Cave after Electrochemotherapy of a Colorectal Liver Metastasis

3.6 Vascular Miscellaneous Cases

3.6.1 Arterioportal Fistula Following Microwave Ablation of Subcentimeter Liver Metastasis from Sigmoid Adenocarcinoma

3.6.2 Arteriovenous Fistula after Diagnostic Renal Puncture

3.6.3 Laceration of the Left Hepatic Artery during Biliary Drainage

3.6.4 Renal Artery Pseudoaneurysm Post Percutaneous Kidney Biopsy

3.7 Neurologic Event

3.7.1 Complete Motor Deficit of the Lower Limbs during Celiac Plexus Neurolysis

3.7.2 Nontarget Embolization during Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment: Be Aware of the Arteria Radicularis Magna

3.8 Pneumothorax

3.8.1 Delayed Pneumothorax after Lung Biopsy

3.8.2 Pneumothorax during Microwave Ablation for Treatment of a Single Pulmonary Metastasis

3.8.3 Pneumothorax during Diagnostic CT-Guided Lung Puncture

3.8.4 Intraprocedural Pneumothorax after Biopsy before Microwave Ablation

3.8.5 Pneumothorax after Percutaneous Lung Interstitial Brachytherapy in Solitary Colorectal Adenocarcinoma Metastasis

3.9 Skin Burn

3.9.1 Skin Burn after Radiofrequency Ablation of Lung Nodule

3.9.2 Burned Skin after Radiofrequency Ablation for Osteoid Osteoma Treatment

3.9.3 Skin Burn after Dislocation of a Microwave Ablation Electrode during Ablation of Liver Metastases in Coaxial Technique

Index

Foreword

Interventional radiologists (IRs) must be aware of the complications of the procedures that they undertake. It is important to note that while all procedures are associated with a list of common complications, some of them may be associated with more esoteric complications, which even though occur rarely, but which IRs should be cognizant of. Every IR should be able to identify the complications and should know the methods of preventing and managing these.

The first step in the management of complications is the knowledge of how to prevent them. Before starting a procedure, the IR should plan each step of the procedure. The old adage “failing to plan means planning to fail” suits best for interventional-radiology procedures. While preparing for a procedure, an IR must consider all the potential complications and plan the procedure around the avoidance of the main complications. Before initiating a procedure an IR should always question “What is the worst thing that can happen in this procedure?” This will help to shift the focus of the IR on avoidance of that complication. For example, when planning to convert a patient with an internal/external biliary drainage catheter to an internal metallic stent, a worst-case scenario in this procedure is losing access when removing the internal/external biliary catheter before inserting the metallic endoprosthesis. If the IR recognizes the potential of this catastrophe, he/she will take extra steps to avoid this situation.

Another important step in the prevention of complications is the use of a safety checklist as described in Chapter 2.1 The success of a preprocedural checklist before embarking on a procedure is well established and IRs must routinely use a checklist to minimise avoidable complications and mistakes.

The CIRSE classification system was created to provide IRs with a practical method of classifying complications in terms of their severity, management, and implications for any required additional treatment and prolonged hospital stay.2 IRs should utilise this easy-to-use classification system in their everyday practice.

The editors, Stefan Mueller-Huelsbeck and Thomas Jahnke, have already published a book on complications of vascular interventional radiology procedures. This new book is a companion to the previous book and is focussed on complications of non-vascular and oncological radiological interventions. Both of them are senior interventional radiologists with a worldwide reputation for excellence.

The editors have assembled an outstanding selection of interventional radiologists from around the world who have provided cases that are focussed on various complications. Each case follows a standardised layout and a consistent approach to each complication for the ease of understanding of readers. The cases are divided into categories based on specific type of complications presented. For example, there are sections on bleeding, cement extravasation, and device failure, etc. The cases are beautifully illustrated by images and line drawings to help the reader grasp the concept well.

I would like to congratulate the editors for assembling this magnificent compendium of complications. The book will be of immense value to practising interventional radiologists and trainees.

1. Haynes AB, Weiser TG, Berry WR, et al. Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009; 360(5): 491–499

2. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse Quality Assurance Document and Standards for Classification of Complications: The CIRSE Classification System. Cardiovasc Intervent Radiol. 2017; 40 (8):1141–1146

Robert Morgan, MRCP, FRCR, EBIRPresidentCardiovascular and Interventional Radiology Society of Europe (CIRSE);Consultant Interventional and Diagnostic RadiologistSt George's University Hospitals NHS Foundation TrustLondon, UK

Preface

Almost 50 years ago, Charles Dotter performed the first successful angioplasty on an 85-year-old female suffering from gangrene of the forefoot. The procedure was reported successful, resulting in wound healing after minor amputation. Since then, interventional procedures evolved into a widely used approach for treatment of vascular and non-vascular diseases.

Minimally invasive interventional procedures are effective in majority of cases, and are generally characterized by high technical success and low complication rates. However, in case of a few vascular and non-vascular oncologic procedures, adverse events with potentially serious outcomes may occur. In the majority of such cases, complications can be managed by interventional means during or after the initial procedure and are not associated with negative sequelae for the patient. Unfortunately, in some cases, the complications result in serious adverse consequences, causing deterioration of the patients’ health for a certain period of time and sometimes even lifelong.

In the first edition of our book we focused on vascular interventional complications and their management. In this edition we have provided a review of complications that may occur during nonvascular interventional therapy and interventional oncological procedures. This edition comprises 45 complication cases that are contributed by renowned specialists in the field. Each case is based on real-life experiences of these specialists and consists of take-home messages for the readers to help them deal with potential problems they may face during their daily interventional practices.

This book will be an invaluable sourcebook for physicians performing non-vascular and oncological interventions. It will aid them to detect as well as avoid and/or manage complications; this book will also help in improving patient care.

The case selection does not claim to be complete in terms of finding the ideal solution to manage a particular problem, however, we hope that the readers will benefit from real-life experiences shared by experienced specialists.

We hope readers will find this compendium an interesting and useful contribution in their daily practice.

Stefan Mueller-Huelsbeck, MD, PhD, EBIR, FICA, FSIRThomas Jahnke, MD, PhD, EBIR, FICA, FSIR

Contributors

Adam Hatzidakis, MD, PhD, EBIR

Associate Professor of Radiology

Department of Medical Imaging

University Hospital of Heraklion Crete

Heraklion, Greece

Afshin Gangi, MD, PhD

Professor of Radiology

Department of Interventional Radiology

University Hospital of Strasbourg

Strasbourg, France

Alessandro Lunardi, MD

Interventional Radiologist

Division of Interventional Radiology

University of Pisa

Pisa, Italy

Antonio Basile, MD, EBIR, FCIRSE

Associate Professor of Radiology

Department of Medical Sciences, Surgical, and Advanced Technologies

University of Catania

Catania, Italy

Athanasios Pantos, MD, MSc

Interventional Radiologist

Aberdeen Royal Infirmary Hospital

Aberdeen, UK

Attila Kovács, MD

Head of the Clinic

MediClin Robert Janker Clinic

Bonn, Germany

Constantinos T. Sofocleous, MD, PhD

Assistant Professor

Interventional Radiology Service

Memorial Sloan Kettering Cancer Center

New York, NY, USA

Dimitrios Filippiadis, MD, PhD, MSc, EBIR

Assistant Professor of Diagnostic and Interventional Radiology

Second Department of Radiology

Medical School, University of Athens

Attikon University Hospital

Athens, Greece

Dimitrios Samonakis, MD

Consultant Gastroenterologist

Department of Gastroenterology

University Hospital of Heraklion Crete

Heraklion, Greece

Douglas Silin, MD

Assistant Professor

Department of Radiology and Biomedical Imaging and Department of Vascular and Interventional Radiology

Yale School of Medicine

New Haven, CT, USA

Frédéric Deschamps, MD, PHD

Interventional Radiologist

Department of Interventional Radiology

Institut Gustave Roussy

Villejuif, France

Garnon Julien, MD

Associate Professor of Radiology

Department of Interventional Radiology

University Hospital of Strasbourg

Strasbourg, France

Georgia Tsoumakidou, MD

Department of Radiology

University Hospital of Strasbourg

Strasbourg, France

Ieva Kurilova, MD

PhD candidate

Department of Radiology

The Netherlands Cancer Institute

Amsterdam, The Netherlands

Ioannis Dedes, MD

Interventional Oncologist

Department of Diagnostic and Interventional Radiology

Interbalkan European Medical Center

Thessaloniki, Greece

Irvin Rexha, MD

Postgraduate Associate

Department of Radiology and Biomedical Imaging

Yale University School of Medicine

Berlin, Germany

Jean Caudrelier, MD, PhD, FRCPC

Radiation Oncologist

Department of Radiation Medicine

The Ottawa Hospital

Ottawa, Canada

Karin Steinke, MD, PhD

Diagnostic/Interventional (non-vascular) Radiologist

Department of Medical Imaging

Royal Brisbane and Women’s Hospital

Queensland, Australia

Koch Guillaume, MD

Interventional Radiologist

Department of Interventional Radiology

The University Hospitals of Strasbourg

Strasbourg, France

Lambros Tselikas, MD

Interventional Radiologist

Department of Interventional Radiology

Gustave Roussy

Paris, France

Laura Crocetti, MD, PhD

Professor

Division of Interventional Radiology

University of Pisa

Pisa, Italy

Milena Miszczuk, MD

Junior Doctor

Department of Radiology and Biomedical Imaging

Yale School of Medicine

New Haven, CT, USA

Miltiadis E. Krokidis, MD, PhD, EBIR, FCIRSE, FRCR, FSIR

Consultant Vascular and Interventional Radiologist

Department of Radiology

Cambridge University Hospitals NHS Foundation Trust

Cambridge, UK

Nariman Nezami, MD

Resident Diagnostic Radiology

Department of Radiology and Biomedical Imaging and Department of Vascular and Interventional Radiology

Yale School of Medicine

New Haven, CT, USA

Nikolaos Galanakis, MD

Radiology Resident

Department of Radiology

University Hospital of Heraklion Crete

Heraklion, Greece

Piercarlo Rossi, MD

Interventional Radiologist

Division of Diagnostic and Interventional Radiology

University of Pisa

Pisa, Italy

Rajasekhara R. Ayyagari, MD

Assistant Professor

Department of Radiology and Biomedical Imaging and Department of Vascular and Interventional Radiology

Yale School of Medicine

New Haven, CT, USA

Roberto Cioni, MD

Interventional Radiologist

Division of Interventional Radiology

University of Pisa

Pisa, Italy

Roberto Luigi Cazzato, MD, PhD

Associate Professor of Radiology

Department of Interventional Radiology

University Hospital of Strasbourg

Strasbourg, France

Samuel Lewis Rice, MD

Assistant Attending of Diagnostic and Interventional Radiology

Department of Radiology

Netherlands Cancer Institute

Amsterdam, The Netherlands

StefanMueller-Huelsbeck, MD, PhD, EBIR, FICA, FSIR

Professor of Radiology, Board Certified Neuroradiologist

Department of Diagnostic and Interventional Radiology and Neuroradiology

Diakonissen Hospital Flensburg

Flensburg, Germany

Thierry de Baere, MD

Department of Interventional Radiology

Faculty of Medicine, Paris-Sud University

Paris, France

Thomas K. Heimberger, MD

Professor

Department of diagnostic and interventional radiology and nuclear medicine

Hospital of the Technical University of Munich

Munich, Germany

Thomas Jahnke, MD, PhD, EBIR, FICA, FSIR

Professor of Radiology

Department of Diagnostic and Interventional Radiology and Nuclear Medicine

Friedrich-Ebert-Hospital Neumuenster

Neumuenster, Germany

Yasuaki Arai, MD, FSIR, FCIRSE

Executive Advisor to President, National Cancer Center

Department of Diagnostic Radiology

National Cancer Center Hospital

Tokyo, Japan

1 Introduction

Non-vascular and oncologic interventional procedures are increasingly performed worldwide. They are mainly carried out by interventional radiologists and almost all interventional radiology (IR) units impart these services since they are minimally invasive and provide the opportunity to gain excellent therapeutic options for the patient, thereby increasing quality of life, and overall survival. The first step of IR is often percutaneous liver biopsy, which is the minimally invasive gold standard for the histopathological evaluation of liver lesions. If the suspected diagnosis is proven by the pathologist, percutaneous thermal ablation procedures are preferred for patients who are not amenable to classical surgery. These minimal invasive options are performed with the help of regional or general anaesthesia and they have revolutionized local tumor destruction. Ablative therapies offer multiple advantages―they have no specificity for selected tumor cells, they are tissue-saving, and they show a reduced rate of morbidity and mortality both in young and elderly patients; they can be performed in conjunction with other cancer treatments and may be repeated if necessary; they require mostly only conscious sedation and local anesthesia, and last but not the least, they go along with shorter hospital stay. In liver lesions with typical imaging features for malignancy, biopsy and ablation can be performed in one intervention in order to minimize trauma. In these cases a coaxial system with the possibility to perform biopsy and ablation successively is preferred.

In specific case, for example for patient with oligometastatic pulmonary secondary malignancies, surgical resection is considered potentially curative and has shown evidence to improve survival. However, frequent surgery is not feasible either due to medical and technical reasons or it is refused by the patient. In these cases, minimally invasive therapies have attained increasing utilization, especially thermoablative techniques like radiofrequency and microwave ablation. Thermal ablation techniques are limited to lesions that are not larger than 5 cm in diameter, and success can be impaired by heat deflection in the vicinity of the vessels. Percutaneous computed tomography–guided interstitial high-dose-rate brachytherapy (iHDR BT) enables the highly conformal administration of therapeutic radiation doses to a circumscribed volume. iHDR BT utilizes a fundamentally different technology from thermal ablation and due to this reason it is independent from the above-mentioned limitations. Moreover, the dose decreases rapidly outside the target volume so that the surrounding healthy tissues can be protected. Because the aim of iHDR BT is not to destroy the target tissue during the intervention, but to induce tissue necrosis developing during approximately 6 weeks in the postinterventional phase, the risk potential of this intervention is comparable to a biopsy procedure. However, every percutaneous manipulation in the lung carries the risk of pneumothorax (3.1% in biopsy).

IR can also provide other services in addition to treating local tumors, for example, with the help of local tumor ablation techniques.

Kyphoplasty is a different approach to treat a patient; Balloon kyphoplasty (BK) is effective for the therapy of vertebral compression fractures (VCF) in terms of immediate pain relief, decreased need for painkiller medications, quick functional recovery, and increased mobility. In case of elderly osteoporotic patients who are not amenable for surgery, the pain leads to immobilization, hospitalization, and adjunctive secondary complications. BK is an alternative to conservative medical therapy as well as to stabilizing spine surgery, enabling rapid patient mobilization and prompt reintegration into the social environment. Pain reduction is more pronounced in BK (92%) as compared to vertebroplasty (87%). This might be attributed to the restoration of the collapsed kyphotic angle in BK. The most frequent complication following vertebroplasty and BK is fracture of the adjacent level (41% in vertebroplasty and 30% in BK). This is associated with cement endplate extravasation isolated to the anterior third of the vertebral body.

The examples provided above reflect only some facettes of non-vascular and oncologic services of IR. Due to recent developments in this field, there is a demand for more information about these procedures. This book tries to provide further information on potential and most frequent complications of the procedures in terms of indications and limitations. Reporting procedural complications and discussing their treatment options as well as potential strategies to avoid them will not only enrich the armamentarium of the readers but also help them avoid complications in the first place and to react better in case they occur.

Thomas Edison once said, “Experience is merely the sum of all our mistakes.” To some extent this holds true for physicians. In medicine, however, we should rather be able to learn from mistakes that others have made in order to keep harm from our own patients.

2 Minor and Major Complications

2.1Definition and Reporting System of Complications

Interventional radiology (IR) provides a wide variety of vascular, non-vascular, musculoskeletal, and oncologic minimally invasive techniques that are aimed at therapy or palliation of a broad spectrum of pathological conditions. Outcome data for these techniques are globally evaluated by hospitals, insurance companies, and government agencies targeting a high-quality health care policy, including reimbursement strategies. To analyze effectively the outcome of a technique, accurate reporting of complications is necessary. Throughout the literature, numerous classification systems for grading complications have been reported. Until now, there has been no method for uniform reporting of complications both in terms of definition and grading. In 2017 a document was developed by CIRSE called the CIRSE guideline with an aim to a classification system of complications based on combining outcome and severity of sequelae. CIRSE also developed a patient safety checklist, the use of which is of paramount importance. Using the CIRSE patient safety checklist to ensure practice of homogeneity among different individuals and departments is essential in all IR procedures. In a similar way, reviewing and grading complications should be performed in terms of a uniform and accurate reproducible and validated categorization system.

Only by using a safety checklist, there is a 36% decrease of major complications and postsurgical mortality rates. The Society of Interventional Radiology distinguishes minor and major complications. The definitions of these complications are as follows:

Minor complication: Treatment-related adverse event requiring nominal therapy or no treatment with or without overnight hospitalization for observation.

No therapy, no consequence.

Nominal therapy, no consequence; includes overnight admission for observation only.

Major complication: Treatment-related adverse event requiring further therapy with increase in the level of care or prolonged hospitalization.

Require therapy, minor hospitalization (< 48 hours).

Require major therapy, unplanned increase in level of care, prolonged hospitalization (> 48 hours).

Have permanent adverse sequelae.

Result in death.

The CIRSE classification system for complications is defined as follows:

Grade 1: Complication during the procedure that could be solved within the same session; no additional therapy, no postprocedure sequelae, no deviation from the normal post-therapeutic course.

Grade 2: Prolonged observation including overnight stay (as a deviation from the normal post-therapeutic course <48 hours); no additional postprocedure therapy, no postprocedure sequelae.

Grade 3: Additional postprocedure therapy or prolonged hospital stay (>48 hours) required; no postprocedure sequelae.

Grade 4: Complication causing permanent mild sequelae (resuming work and independent living).

Grade 5: Complication causing permanent severe sequelae (requiring ongoing assistance in daily life).

Grade 6: Death.

The main aspect for consideration is that a complication that can be treated during the same procedure should be stated as minor complication (grade 1), emphasizing the importance of complications’ management through interventionalists.

Further Reading