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SIR Issues Position Statement on Endovascular Interventions in Trauma Care

The Society of Interventional Radiology (SIR) has published a position statement outlining the parameters trauma centers need to meet when using endovascular interventions to treat cases of traumatic injury. The position statement, recently published in the Journal of Vascular and Interventional Radiology, was written by a multidisciplinary group of experts composed of members from IR, trauma surgery, orthopedic surgery, and vascular surgery.

“Endovascular intervention plays a critical role in the care of the trauma patient, improving survival, reducing morbidity, and decreasing blood loss,” says SIR president Laura Findeiss, MD, FSIR. “When delivered promptly, it is highly effective in treating bleeds throughout the body, including in the liver, spleen, kidneys, and pelvis—saving lives and saving function.”

While traumatic injury is the leading cause of death for people younger than 45, the mortality rates have dropped due to better integration of multidisciplinary care, faster access to advanced imaging and interventions, and use of nonoperative management in specific scenarios.

“This position statement sets out important recommendations to ensure that the appropriate level of knowledge and expertise are available among all members of the trauma team to ensure that the right care is delivered as swiftly as possible,” Findeiss says.

Recommendations offered in the position statement include the following:

• immediate 24-hour access to an interventional angiography facility;
• a multidisciplinary team that includes specialists who can perform large- and small-vessel endovascular interventions;
• the ability for an interventional team to be ready within 60 minutes from the time a multidisciplinary team decides to proceed with an endovascular intervention; and
• the development of, and adherence to, evidence-based treatment algorithms for each trauma scenario, for both adults and children.

The full position statement and recommendations are available at jvir.org.

— Source: Society of Interventional Radiology

Interventional Radiologists Can Be ‘Game-Changers’ in Kidney Cancer Treatment

For some patients, kidney cancer can be effectively treated without surgery, according to the Society of Interventional Radiology (SIR)’s first-ever position statement on the role of percutaneous ablation (PA) in the treatment of renal cell carcinoma (RCC). The position statement was published with an accompanying quality improvement document, which establishes performance thresholds for patient safety for IR groups who wish to develop a renal ablation practice.

RCC is the most common type of kidney cancer. An estimated 73,820 new cases of kidney cancer will be diagnosed in the United States in 2019, resulting in 14,770 deaths.

The position statement and quality improvement document, recently published in the Journal of Vascular and Interventional Radiology, were written by a multidisciplinary group of experts, including interventional radiologists and urologists. The authors recommend thermal PA for kidney cancer patients with small renal tumors, calling it “a safe and effective treatment with less complications than nephrectomy [surgery] and acceptable long-term oncological and survival outcomes.”

Unlike current existing guidelines, the position statement offers recommendations on the consideration of treatment over active surveillance; it also discusses the incorporation of ablation for appropriate patients with T1b disease.

“Interventional radiologists are critical members of the multidisciplinary team caring for patients with kidney cancer. They have an important role, not only in the diagnosis of cancer but in its definitive treatment,” says SIR president Laura Findeiss, MD, FSIR. “An image-guided biopsy by an interventional radiologist can confirm a diagnosis of cancer, and the interventional radiologist can be a game-changer as a partner physician on the cancer care team, expanding access to the complete range of therapeutic options tailored to the individual patient.”

The position statement’s authors deemed radiofrequency ablation, cryoablation, and microwave ablation “appropriate modalities,” noting that the “method of ablation should be left to the discretion of the operating physician.” According to the statement, PA may have a potential beneficial role to play in the treatment of high-risk patients with more advanced disease who are not candidates for surgery, but further research is necessary.

— Source: Society of Interventional Radiology