AJ Gunn
@ajgunnmd
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Following
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Rosie’s dad | Penny’s best friend | Passable husband to @LyndsayGunn | Interventional Radiologist | @Cubs fan | Bogey golfer
Birmingham, AL
Joined August 2015
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Pleased to share that I got promoted!
Thanks to
@RaisBahrami
,
@janjansenuk
,
@freez_IR
,
@LukeWilkins_UVA
,
@DrCliffWeiss
,
@gdkennedy88
,
@rkryu
, so many other non
#TwittIR
mentors from
@MGHIR1
,
@uab_ir
,
@JohnsHopkinsIR
, &
@WashUIR
that helped me along the way!
#IRad
59
6
229
They can’t fire me now 😂😂😂
I am feeling very grateful to those who have supported and mentored me along the way!
@DrCliffWeiss
@LessneVIR
@DanSzeMDPhD
@danbrownIO
@freez_IR
@MGHIR1
@covey_md
@thefibroidlady
@janjansenuk
@RaisBahrami
35
2
181
Quick
#IRad
PSA:
Flipped PICCs do not always need to be exchanged. Sometimes, just flushing the catheter firmly with a 1cc or 3cc syringe is enough.
I’ll admit that the below video is the first time I have used this trick on a small-bore tunneled central venous catheter.
9
22
135
My last uterine
#fibroid
embolization consult had to self refer because her local community gynecologist told her, “UFE doesn’t work.”
We have ~30 years of experience & multiple randomized trials demonstrating that UFE *does* work. It’s a great uterus-sparing option for women!
9
26
114
Today is 17 years since the best decision I’ve ever made - amazing to have a friend & partner like this thru med school, research year, the recession, the match, infertility treatments, birth of a child, training, parents’ death, Cubs World Series, & a global pandemic.
13
1
114
Interventional radiology consulted for obstruction due to
#PancreaticCancer
after failed endoscopic stent placement. Single session percutaneous biliary access with covered stent placement, and no biliary drain. In
#IRad
clinic two weeks later, bilirubin down to 2.1 from >23.
3
17
107
OSH Trapease migrated to heart &
#patient
heading to OR before
#irad
@uab_ir
got involved ->
#filterOUT
in combination w
@NathanErtel
-
#GTFO
13
32
103
Awesome to have this little one assist me today
@uab_ir
! Thanks to the staff who decked her out in a scrub cap, mask, & shoe covers. It made her feel in the moment & her feedback on my
#IRad
technique was priceless.
#perfectionist
#whatsrosiedoing
#radXX
#ILookLikeADoctor
4
2
103
Metastatic
#breastcancer
to the mediastinum occluding the superior vena cava resulting in neck, arm, and facial swelling. This was treated by interventional radiology (
#IRad
) in a single session with lysis, thrombectomy using
@PenVascular
Lightning 12, and stent placement.
3
16
104
Superior hypogastric nerve block has been a very helpful adjunct to uterine artery embolization to improve patient comfort & facilitate same day discharge. Big thanks to
@keithppereira
for his
@cvirendo
article on the topic, which makes the procedure quite easy to do.
5
24
102
Sorry that you have to zoom in on the photo but very excited to share the updated
@NCCN
guidelines for RCC, that now include MWA as a treatment modality and ablation in general as an option for patients with T1b tumors.
Thanks to
@ONealCancerUAB
for having me on this panel!
4
28
101
Problem-solving in complex cases + assisting surgical colleagues =
#IRad
Post-operative biliary obstruction treated with image-guided creation of new connection between biliary tree & bowel, eventually placed a covered biliary stent to secure that will be changed by
#endoscopy
6
16
98
Based on the pre-procedure CT, I would have expected this to be a relatively straightforward ablation. Of course, things often change based on positioning and respirations.
We created an intentional pneumothorax to protect the lung & create a direct route to the tumor.
#IRad
8
9
94
Enterocutaneous fistulas from surgery, radiation, infection, or other causes can be a life-limiting problem with few treatment options for many patients. An enterocutaneous fistula plug from
@CookMedical
placed by interventional radiology (
#IRad
) can be a huge win for patients.
5
16
94
Excited to announce that the next
@SIRspecialists
National Virtual AngioClub will be held on Wednesday, May 26 at 8PM EDT
Submit a case for the opportunity to present here:
You can register for the event at the same site. Don’t miss out!
5
47
86
Anticoagulants are not benign medications. In interventional radiology, we see many retroperitoneal & rectus sheath hematomas due to anticoagulants. Some, like this patient, develop life-threatening bleeding. Fortunately,
#IRad
was able to stop the bleeding w/ coil embolization.
7
15
90
Great way to start 2024 by getting this manuscript accepted by
@JVIRmedia
!
We performed percutaneous cryoablation of 94 central renal tumors without pyeloperfusion, and basically found that rates of major AEs were not any higher than is reported for all renal ablation cases.
4
10
87
My daughter with a heartfelt thank you to all the healthcare workers
@uabmedicine
& elsewhere who are on the frontlines taking care of patients!
#HappyDoctorsDay
@UABSOM
@uabRadResidents
@SIRspecialists
@cityofbhamal
@randallwoodfin
@DrVickersUAB
3
8
84
We are just 3 weeks away from moving into our brand new clinic space!
#IRad
@uab_ir
@thefibroidlady
@Bama_IR
@WoodRiley
@junjian_huang
@parkhurst42
@UABRadiology
@uabmedicine
9
5
83
Fibroids are common, non-cancerous growths in the uterus that can cause bleeding & pain. It is the
#1
reason for hysterectomy in the US but it doesn’t have to be this way. Uterine fibroid embolization is a safe, tested, & non-surgical approach that ⬇️ symptoms in 90+% of women.
2
20
81
We are excited to match these two awesome future
#IRad
into our program
@uab_ir
! The whole team is looking forward to working with them & being a part of their growth as physicians. Expecting big things in 2023….
#radres
#Match2022
2
8
81
Hey
#medstudents
,
#radres
, &
#IRad
residents, make sure to download the SIR Guidelines App for all your questions about periprocedural medications & antibiotics. It’s a must-have for your
#IRad
rotations.
App Store:
Google Play:
4
24
80
Every so often in
#IRad
, you can save a life. This patient had hemorrhagic shock due to bleeding after a renal biopsy. Image-guided embolization of the bleeding artery was performed. The patient nearly immediately went off pressors and returned to normal systolic blood pressure.
7
7
78
We have a real need to recruit, train, & fund positions for interventional radiology (
#IRad
). This graph is out of control & bad for
#patient
care.
Thx to
@Drshiloh
for sharing w/ me.
@AmerMedicalAssn
@SIRRFS
@ACRRAN
@RadiologyACR
@SIR_ECS
@GrrlMD
@acgme
@ASlavitt
@CheriCanon
7
46
77
Since opening the interventional radiology (
#IRad
) clinic
@uabmedicine
in late 2016, we have expanded to four days per week, hired full time staff, & see ~1,400 patients per year.
Here are screenshots of my clinic days the past two weeks. We treat a wide variety of patients!
1
5
72
Beautiful demonstration of a conventional chemoembolization for a patient with
#livercancer
, especially when follow up imaging shows a complete response. Interventional radiology is an important piece of caring for patients with cirrhosis and liver cancers.
#IRad
#LiverTwitter
3
20
76
Our ambulatory clinic opened in November 2016. Four years later, we have expanded to full time support staff, an additional PA, & seeing patients either in person or virtually five days a week. We have >2000 patient visits each year because
#IRad
is a clinical specialty!
4
1
75
Hey
@CNN
, nice piece but you might want to ask an interventional radiologist about this because we’re the ones who would actually do the procedure!
#IRad
@SIRspecialists
@GrrlMD
@TirathPatelMD
@RichDuszak
@drsanjaygupta
@NBCNews
@ABC
@CBS
@FoxNews
4
18
76
Prelim data ✅
Funding from
@PenVascular
✅
Sites selected ✅
IRB submitted ✅
Trial registered ✅
Excited to begin our mulitcenter, prospective, randomized trial in splenic trauma with
@UABSurgery
,
@UTHouston_IR
,
@wakehealthIR
,
@prismahealth
in Greenville, SC, &
@OSURadiology
!
5
9
75
Occluded bile duct stent causing elevated bilirubin levels, precluding chemotherapy.
After failing from above, we stuck the stent percutaneously, crossed from below, snared the wire, & advanced the sheath past the occlusion, leaving an internal/external drain.
5
10
75
Angiomyolipomas are benign renal tumors that can rupture, causing life-threatening bleeding. This patient was offered total nephrectomy 😳 at an another hospital. Interventional radiology (
#IRad
) was able to selectively embolize the tumor, while saving the renal parenchyma.
2
13
74
Interventional radiology (
#IRad
) removes areas of infection inside the body by placing drains under imaging guidance, helping patients heal faster than with antibiotics alone
This has replaced surgical approaches in most instances due to its low cost, safety, and efficacy
0
12
72
Celebrating 19 years married tonight in Austin. We haven’t perfected our
@BoyzIIMen
harmonies but have pretty much nailed everything else about marriage
And nothing says academic medicine like having your anniversary after the
@theAPDIR
meeting today and before
#AUR23
tomorrow
9
1
74
Celebrating our 18th wedding anniversary today…(insert something romantic/loving here)!
10
1
74
When placing an IVC filter, the cava can be compressed which makes it appear larger in diameter on the AP view. In these cases, you can check an oblique view to make sure it’s safe to place the filter. Here, the cava was ~35mm on an AP view but only ~15mm on a 50LAO view.
#IRad
4
8
72
Intra-hepatic
#cholangiocarcinoma
in a non-surgical patient treated with intra-arterial delivery of radiotherapy directly to the blood vessels supplying the tumor by interventional radiology (
#IRad
) with a nice response on follow up.
1
13
71
Patient with intrahepatic
#cholangiocarcinoma
treated with radioembolization by interventional radiology (
#IRad
). During mapping, there was a small arterio-portal shunt that was coil embolized. The post delivery SPECT CT shows excellent targeting of the tumor.
1
7
72
Excited to see our prospective pilot trial of proximal splenic artery
#embolization
in trauma in print! You can check it out here: . 98% splenic salvage!
@janjansenuk
@dotter_IR
@TheRealDoctorOs
@JuliusChapiro
@wakehealthIR
@ahmed_kamel_ir
@traumadoctors
3
18
70
Too many people to thank but feeling very lucky & fortunate to have been mentored & befriended by so many great people.
Congrats to
@rahulshethmd
@ABrandisMD
@jdkubanMD
@kmadass
@TheRealDoctorOs
@keithppereira
@GabGabrielMD
@MoonJustaniah
@zachbercu
@sethb_md
& many others!
7
0
71
Assisting our surgical colleagues is one of the best parts of interventional radiology. This patient had an anastomotic leak after a Whipple, and was transferred to
@uabmedicine
after a failed PTC at an OSH. It was a 30 min procedure with
#IRad
resident
@KieraMurphy10
.
5
3
70
What struck me most as true:
1. “Happy” MDs die by suicide
2. Patient deaths hurt MDs
3. Blaming MDs increases suicide
4. MDs don’t seek help bc we fear it won’t be confidential
At the least, use this to be there for someone who may need it.
4
57
68
Follow up MRI approximately two years after uterine fibroid embolization. There is a clear lack of enhancement with a reduction in size by ~50%. The patient says that she’s having normal cycles for the first time since she was 11 years old. Talk to your doctor…
#ufeworks
2
16
70
This patient could not lay prone due to back issues so we took a trans-hepatic route to ablate this
#kidneycancer
.
Two thin needles placed under CT guidance by interventional radiology (
#IRad
) were all that was needed to freeze this
#cancer
to death.
3
11
68
If you have
#kidneycancer
, make sure you speak with an interventional radiologist. While not right for everyone, many tumors can be treated by a needle placed through the skin into the tumor under imaging guidance. This outpatient procedure is safe & effective.
#IRad
0
12
69
An example of a typical morning in the
@uab_ir
ambulatory clinic
@uabmedicine
, an important part of the modern interventional radiology (
#IRad
) practice.
Clinic volume is ⬆️ 25% from last year necessitating new staff and expansion to five days/week!
#ptexp
#IAMIR
8
13
69
We received *final* IRB approval the ELSA 2 trial, a multi center randomized trial comparing endovascular coils to vascular plugs for proximal splenic artery embolization in
#trauma
being run by
@uab_ir
and
@UABSurgery
Keep an eye out for its own account coming soon!
#IRad
4
7
70
Great to be able to ✅ off one career goal!
I just updated my CV & now have 100 manuscripts published or in press. I had an attending tell me it couldn’t be done without an “army” of people writing for me but, with collaborators, we got it done in ~ 8 years.
7
2
69
Post-Whipple bile duct obstruction crossed with some effort by interventional radiology (
#IRad
), followed by cholangioplasty and large bore biliary drain. We keep this in place for ~6 months before attempting to remove.
What is your group’s benign biliary stricture protocol?
11
6
69
Live action shots performing laser lithotripsy in a non-surgical candidate with cholelithiasis using
@bostonsci
Spyglass scope.
Nice
@uab_ir
to have a strong collaboration with
@AliMirAhmedMD1
,
@JBartRose
,
@DrReddy_HPB
, & others to support this expansion in our
#IRad
practice.
3
10
69
Small area of metastatic
#neuroendocrine
tumor in the liver that was burned to death via a thin needle placed by interventional radiology (
#IRad
) under CT guidance during an outpatient procedure. Follow up DOTATATE PET shows an excellent response to treatment.
2
14
67
Very excited & grateful that the contracts for our prospective, multi-center trial evaluating renal embolization prior to ablation are finalized.
We should be enrolling
@uabmedicine
soon, partnering with
@MayoClinic
,
@Penn_IR
,
@StanfordRad
,
@JeffersonRads
, and
@VarianMedSys
.
2
2
68
Great job by
@junjian_huang
getting this article out in the upcoming Seminars in Interventional Radiology issue
On top of this, he has been key in building a robust kyphoplasty, Spine Jack, basivertebral nerve block, and all around pain practice
@uabmedicine
1
8
69
✅ project funded
✅ approved as a coordinating site
✅ sites selected
✅ approved as a trial site
Just waiting on the final documents to be signed to begin enrolling in our renal embolization + ablation trial!
Thanks to
@VarianMedSys
for believing in this idea!
8
3
68
Classic case for
#radres
&
#IRad
residents preparing for upcoming
@ABR_Radiology
exams.
Diagnosis here:
9
4
66
Even “simple” image-guided procedures can have huge impacts on patient care. Here, an undrained component of pancreatic necrosis was causing persistent fevers & elevated white count.
#IRad
used a small opening behind the colon but anterior to spleen to place a drain.
4
10
66
And my last planned tweet of 2020...
This
#patient
gets to experience
#Christmas
cancer-free after having x-ray guided delivery of chemotherapy directly into the blood vessels supplying the tumor by interventional radiology (
#IRad
). A beautiful sight to behold!
3
14
63
Compassionate care is essential care.
Intractable abdominal pain due to
#PancreaticCancer
relieved with an image-guided celiac plexus block by interventional radiology (
#IRad
)
@uab_ir
.
#Patient
was able to sleep for the first time in weeks & was able to be discharged.
5
14
66
Great anatomic variant seen
@uab_ir
during a splenic artery
#embolization
for trauma. The splenic artery is arising from the superior mesenteric artery, which occurs in ~0.5% of people.
#IRad
#radres
#radiology
#Medstudent
@Radiopaedia
@ARRS_Radiology
@SIRRFS
@ACRRFS
@theAPDR
9
27
66
Corona mortis, an anatomic variant where the obturator artery arises as a branch off the external iliac artery, occurs in ~20% of patients.
It’s important to identify as it can be a source of continued bleeding after embolization in
#trauma
.
#IRad
#radiology
#FOAMrad
#FOAMIR
1
26
64
A new
@UABSurgery
#trauma
attending: “Wow, you guys embolize everything here!”
#IRad
: Yes, yes we do.
Splenic injury following a car crash treated
@uab_ir
with proximal splenic artery embolization, preserving the spleen & helping to save the patient.
4
10
65
Splenic artery
#embolization
by interventional radiology (
#IRad
) improves outcomes in
#trauma
patients who are selected for non-operative management. Placing the embolic agents in the mid-splenic artery reduces the pressure, prevents ischemia, & allows the spleen to heal.
3
12
63
Endophytic, centrally-located
#kidneycancer
has the highest risk for complication from image-guided ablation by interventional radiology (
#IRad
). We favor cryoablation
@uab_ir
in these situations. This
#patient
was offered total nephrectomy but wanted to preserve the kidney.
2
15
62
Silver anniversaries are great, but not for IVC filters. This filter, placed in 1996, penetrated the caval wall & was causing symptoms. Interventional radiology (
#IRad
) used forceps for this
#filterOUT
.
@rkryu
@TheRealDoctorOs
@LessneVIR
@kush_r_desai
@MustafaAhmedMD
@kmadass
4
8
63