Tad Maguire

Elderly pt, previously ambulatory, admitted w/ intractable pain following a fall. Bedridden, immobilized, requiring IV narcotics. Unable to work with PT/OT.
+SIJ provocative tests.

Complex sacral fx, spanning Denis zones 1-3 out to SI joints, with areas of offset and impaction.

Tandem functional calcific occlusions at adductor canal.

Lithotripsy is a game changer here.

But meticulous intraluminal crossing is key to making this a worthwhile IVL + low pressure PTA/DCB instead of a supera

Recurrent high CFA PsA s/p TAVR despite thrombin injection by other service. Nice demo of internal iliac collateral flow potential to lower extremity in the setting of external iliac/common femoral occlusion, in this case balloon tamponade at neck during perc thrombin injection.

As much as I love curved needle, sometimes you have to be direct.

Trans-SI approach for biopsy & ablation of solitary metastasis of central S2.

@bkeyMD @ChengaziMD @iRadRock @gaurav_gadodia @SIRRFS

~90 yr old pt admitted s/p fall.
Previously ambulatory -> bedridden 10/10 pain & unable to participate w/ PT/OT.
Acute sacral fx extending up along S1 pedicle screws.
Long axis + curved needle sacroplasty FTW!
Up walking POD 1, pain 10 -> 3