Bleeding is an inherent risk in virtually all vascular and interventional radiology (VIR) procedures. Appropriately, all VIR preprocedural assessments should take into consideration a patient's coagulopathic state as a potential contraindication. Coagulopathic abnormalities are particularly common in critically ill patients, many of whom may require emergent, life-saving VIR interventions. As the landscape of VIR transitions toward an emphasis of VIR physicians serving as clinicians rather than proceduralists/technicians, it is becoming more important that VIR physicians understand and provide appropriate clinical recommendations regarding management of common coagulopathies. This section will first cover common anticoagulants and antithrombotic agents, as well as their reversal agents. This will be followed by evaluation and medical management of common critical care coagulopathies such as disseminated intravascular coagulation, heparin-induced thrombocytopenia, uremic platelet dysfunction, and coagulopathy secondary to liver disease. Finally, this discussion will cover the role of blood product transfusions in correcting coagulopathies. Management of various coagulopathies in context of low vs high bleeding risk VIR procedures, as defined by the Society of Interventional Radiology guidelines, will also be discussed. Understanding these common coagulopathies will allow the VIR physician to provide guidance to primary teams in correcting coagulopathic abnormalities so that a VIR intervention may proceed in a timely manner for these critically ill patients.

AKI is commonly seen among hospitalized patients, many of which the VIR is consulted to assess for a potential intervention. Rates are increased for critically ill patients and those with pre-existing CKD, advanced age, or significant comorbidities. Developing an AKI is associated with increased morbidity, mortality, and risk of progression to chronic kidney disease. Physiologically, renal function depends on the coordinated activity of nephrons, which regulate fluid balance, electrolyte homeostasis, and metabolic waste filtration. Disruption of renal perfusion, injury to the microscopic and macroscopic renal structures, or obstruction of urinary outflow can impair these processes and lead to AKI. Clinical evaluation includes a focused history and physical examination, laboratory testing, urine analysis, and imaging studies to determine the underlying cause and guide management. The VIR will frequently encounter patients at risk for or experiencing AKI. For informed discussion with patients and other providers, optimal procedural planning, and enhanced post-procedural care, understanding the distinction between contrast-associated AKI and contrast-induced AKI and possible preventative strategies is vital. Given the enormous negative clinical impact of AKI, the VIR plays an important role in its prevention, diagnosis, and management.

Vascular Interventional Radiologists (VIRs) frequently care for patients with high severity of illness, multiple comorbidities, and physiologic derangements. The incidence and prevalence of abnormal cardiac rhythms (dysrhythmias) in these patients is high, and these can quickly lead to hemodynamic instability, shock, and death. Therefore, VIRs should be skilled in the evaluation and management of common dysrhythmias. Here, we provide an overview of commonly encountered narrow-complex tachycardias, wide-complex tachycardias, and bradycardias, with emphasis on recognition, diagnosis of underlying etiologies, and initial pharmacologic or electrical treatment steps, with the understanding that advanced treatment and long-term management should be undertaken in conjunction with electrophysiology expertise.

Vascular and interventional radiology (VIR) has expanded to include the periprocedural and inpatient management of critically ill patients. Acute respiratory failure and airway compromise in VIR settings may arise from a range of causes, including oversedation, pneumothorax, massive hemoptysis, pulmonary edema, anaphylaxis, or exacerbations of pre-existing respiratory conditions. The ability to promptly assess and treat acutely decompensating patients is essential for interventional radiologists. The management of acute respiratory failure begins with a rapid assessment of airway, breathing, and circulation, in conjunction with evaluation of vital signs, pulse oximetry, end-tidal CO2, arterial or venous blood gases, all while determining the underlying etiology. This review provides a concise overview of the mechanisms underlying respiratory failure, the devices used for monitoring and management, and a focused approach to treating patients with acute respiratory failure.

This review highlights a systematic approach to intraoperative patient safety within vascular and interventional radiology, emphasizing a comprehensive monitoring system that includes airway, respiratory, and circulatory management. Airway monitoring integrates continuous assessment with tiered intervention strategies, ranging from basic oxygen delivery to advanced airway techniques. Respiratory monitoring underscores the critical role of capnography for early detection of respiratory compromise, while circulatory management focuses on the use of arterial lines and immediate defibrillation access. The review offers insights into complications such as contrast reactions, cardiopulmonary arrest, over-sedation, and sepsis, focusing on risks and management. Recognizing acute medical emergencies in the vascular and interventional radiology suite, informed by skilled personnel and a clear understanding of available resources and management practices, establishes a strong foundation for effective emergency preparedness, ultimately enhancing patient safety and outcomes.

Vascular Interventional Radiologists (VIRs) frequently perform procedures to treat active hemorrhage and are consulted for assistance in management of active hemorrhage. Many such patients are critically ill with hemorrhagic shock, and may require complex urgent and medical management by the treating VIR. VIRs should understand the pathophysiology of hemorrhage and guidelines for management. Here, we discuss the assessment of acute hemorrhage, physiology of acute traumatic coagulopathy, and how to manage and resuscitate patients presenting with acute or severe hemorrhage. Importantly, we focus on the evidence-based Damage Control Resuscitation guidelines, transfusion principles, and anticoagulation reversal guidelines. This knowledge will help any VIR to manage patients experiencing hemorrhage and to function as a disease expert and key cog of the clinical team.

Peripheral arterial disease (PAD) is a chronic atherosclerotic disease of the lower extremities associated with high cardiovascular morbidity and mortality, as well as destructive limb-associated complications such as intermittent claudication and ischemic rest pain. While revascularization with surgical and endovascular techniques is important to prevent limb loss in patients with critical limb ischemia, it fails to address the early symptoms of PAD or the systemic cardiovascular risks associated with PAD. The management of PAD incorporates aggressive lifestyle modification and comprehensive medical therapy aimed at reducing systemic cardiovascular risk, preventing limb-related events, and improving quality of life and functional capacity.

Peripheral arterial disease (PAD) continues to pose a major global health challenge, driven by population aging and the growing prevalence of diabetes. Effective management of complex, calcified lesions increasingly relies on targeted plaque-modification strategies that enhance vessel compliance and improve long-term patency. This review summarizes current vessel-preparation tools-including specialty balloons, atherectomy systems, and intravascular lithotripsy-highlighting their mechanisms, indications, limitations, and supporting evidence. While registries and observational studies demonstrate acute advantages such as greater luminal gain, improved drug uptake, and fewer severe dissections requiring bailout stenting, randomized data remain limited and heterogeneous. Key outcomes-including primary patency, distal embolization, and long-term clinical benefit-are inconsistently reported. These evidence gaps underscore the need for standardized endpoints and morphology-specific trials to better define optimal use. Collectively, plaque-modification technologies represent an expanding continuum of vessel-preparation options that complement angioplasty and drug-based therapies, aiming to deliver durable, anatomy-guided, and patient-centered revascularization in peripheral arterial disease.

Noninvasive imaging represents the cornerstone of diagnosis, characterization, and longitudinal management of peripheral arterial disease (PAD), offering both anatomic and physiologic information essential for precision therapy. Each modality-magnetic resonance angiography (MRA), computed tomography angiography (CTA), duplex ultrasonography, and physiologic testing-contributes unique strengths to the comprehensive evaluation of arterial disease. In addition, specialized perfusion-based techniques extend the diagnostic armamentarium for chronic limb-threatening ischemia (CLTI).

The purpose of this chapter is to provide a broad summary of the different classes of wound care products and to show their indications for use while providing a list of the products which are most commonly used in the clinical setting. Wound care is a complex specialty and a thorough understanding of the underlying etiology of a wound is essential in determining which wound care products are best to use. Wound care is a large specialty within podiatric medicine and continues to have a significant impact on health-care expenses in the United States (US). Prompt treatment with a multidisciplinary approach is necessary to reduce the burden of healthcare expenses and prevent the detrimental effects caused by chronic wounds on the quality of life of patients. The different types of wounds will be identified and common diagnostic studies ordered for each type of wound will be discussed. Wound care is a dynamic specialty which requires constant evaluation as changes occur, including revascularization procedures and infections. The presence of simultaneous disease processes that interfere with wound healing also adds to the complexity of treatment. The goal of this chapter is to allow healthcare providers in multiple different specialties to learn more about wound care to treat patients with more effectiveness and efficiency.

Lower extremity amputations secondary to diabetes and vascular disease result in huge costs to the healthcare system and have significant psychological effects on patients. Limb salvage has become an important specialty within podiatric medicine, aiming to keep patient's ambulatory and prevent readmissions and repeat amputations. The purpose of this chapter is to describe the different levels of amputation in the foot and ankle and discuss relevant adjunctive surgical procedures to reduce the risk of postoperative complications. A thorough understanding of the biomechanics of the foot and ankle is necessary. Additionally, it is important to utilize any available vascular imaging or non-invasive vascular studies as well as wound stratification systems when planning amputation levels. Outcomes vary widely depending on perfusion and systemic comorbidities. A multidisciplinary team approach is best in limb salvage to treat underlying systemic illnesses which can result in failure of the amputation. Several factors including the current functional status of the patient, should be considered before selecting a surgical procedure for limb salvage.

Deep vein arterialization (DVA) is an evolving revascularization strategy that offers an option for those who classically are considered as no-option critical limb threatening ischemia (CLTI) patients. This patient population, many who may have had multiple revascularization attempts, or sometimes none, face dangerously high rates of amputation and mortality that has been well described in the literature. These patients suffer from small vessel disease and anatomically demonstrate no suitable vessels for endovascular or surgical revascularization ("desert foot"). DVA creation involves a tibial artery-to-vein fistulization, and after additional interventions, enables retrograde delivery of oxygenated blood down the tibial vein towards the pedal venous arch. This article describes the indications and contraindications, pre-operative evaluation, various approaches to arterialization, and postprocedural DVA management. DVA creation can be a technically challenging procedure, particularly in patients with significant arterial inflow disease burden, difficult-to-navigate venous loops, and those with variable venous anatomy. Post-DVA reintervention is quite common, spanning from management of graft occlusion/stenosis, poor maturation, arterial steal, and venous hypertension. Furthermore, these patients require close clinical follow-up involving regular ultrasound surveillance and close collaboration with foot and ankle surgeons for amputation strategy planning. Lastly, there is a continually growing body of evidence demonstrating the efficacy of DVA as well as the benefits of early reintervention; overall, promising results for patients with no-option CLTI.

Peripheral arterial disease (PAD) presents both a major public-health challenge and a substantial clinical opportunity for interventional radiologists (IRs) to fill local healthcare gaps and disparities. This article is a practical primer for those who want to enter the peripheral arterial disease space and includes clinical assessment and workup for the patient as well as a discussion on education and hands-on training, building a referral base, creating a multidisciplinary limb-preservation program, and tracking outcomes. In the articles that follow in this issue, a more in-depth discussion will provide readers understanding on some of the tools and techniques necessary for clinical knowledge and practice development.