Learning from complications with “Lessons in IR”
The April 2023 issue of the Journal of Interventional Radiology will feature the first in a new series of case-based discussions focusing on common complications, titled “Lessons in IR.” SIR Today spoke with JVIR Deputy Editor Brian Funaki, MD, FSIR, the developer of the new series, to find out more about the cases, format and value this new series will provide to the practicing IR.
What inspired the creation of this series?
Brian Funaki, MD, FSIR: A lot of it had to do with feedback we’d received. Of course, one of the most important functions of JVIR as SIR’s flagship publication is to present and disseminate new information. That said, not all readers have time to keep up with the latest research in every single area of IR—that can be overwhelming. Some of those IRs have they’ve said they would like to see more content that’s relevant to their everyday practice. In order to increase the journal’s accessibility and practicality, we wanted to create something that is more basic and can appeal to a more general audience.
Everyone in medicine sees complications—they’re not unique to IR. There are some very common complications that a lot of IRs will encounter, and discussion of those complications can be a great resource—especially if they’re presented in a concise format that can be easily read and digested in a short period of time.
How are you sourcing the cases and complications you’ll be presenting? Are they new cases?
BF: The first batch of cases we’ll be covering come from a Spring Fellows Practicum morbidity and mortality (M&M) course I’ve run for many years. Every year, we solicit case contributions from the those who come to the meeting, so so we have a large archive going back almost 20 years. While many of these cases are old, they’re often every bit as relevant to today’s IR.
That said, we are being selective and starting small. My co-developer, Divya Kumari, MD, and I have been selecting and writing up some of the best and most relevant ones. The next couple will come from Ran Gaba, from University of Illinois. After that, we hope to develop this into a recurring feature where people can submit their own complications.
What kinds of complications are you looking at?
BF: We’ve tried to pull the classic types of complications that are general enough that many people will see them in many different types of practices. This isn’t Extreme IR—we’re not looking for exotic complications. But unfortunately there are so many different kinds of complications, we could run this series indefinitely without being repetitive. The goal is to present situations that anyone—from medical students to practicing IRs—may encounter.
So far, we’ve written discussions on situations such as a hypertensive crisis after an adrenal biopsy: how do you recognize that? How do you avoid it? How do you manage it? We’re also looking at an example of a guidewire perforation causing a page kidney, as well as a misplaced gastrostomy tube into the peritoneal cavity. Other cases include an evolving hemothorax, and an example of a splenic infarction after a complicated splenic aneurism embolization. We’re trying to include both vascular and nonvascular complications.
You’ve said these will be concise and digestible. What will the format look like?
BF: With each case, we provide a brief discussion of the case, as well as a quick bullet point section that focuses on the recognition, avoidance and management of the complication.
Can you explain why publishing this series of case complication discussions is important to the community?
BF: Complications are probably the best teacher an IR can have. Everyone remembers their complications, even when they’re relatively common and innocuous. This series isn’t intended to be like Extreme IR; we’ll cover cases that readers will recognize and will think about whether or how often they’ve encountered each particular complication, and can then learn how that complication might be handled. Because of how common they can be, it’s important for IRs to not only be aware of the possibilities but to understand how to best treat, recognize and avoid them. Publishing them in the journal is also more impactful than, say, discussing cases on SIR Connect—which is great and helpful, but the suggestions from the community typically aren’t vetted by anyone or include references. The Lessons in IR discussions will go through the journal’s peer review process, and will be more consistently grounded in what’s known and accepted.
Do you have any concerns about publishing content regarding complications?
BF: Unfortunately, complications are part of medicine. That’s why you schedule M&M conferences—because you know you’re doing to have complications to discuss. It makes sense to be aware of potential concerns, because the medicolegal aspects continue to evolve. But this kind of content has always been part of meetings and part of journals. This series is certainly not intended to be an exhaustive review of a certain complication, nor is it intended to be a standard of practice, and I’m sure we’ll include some language to that effect. But it hopefully it will provide a good general consensus opinion of how to approach some of the challenges that many IRs will encounter.
