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  • Safety and Efficacy of Totally Percutaneous Femoral Access for Fenestrated–Branched Endovascular Aortic Repair of Pararenal–Thoracoabdominal Aortic Aneurysms
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2020-01-15
    Mario D’Oria, Gustavo S. Oderich, Emanuel R. Tenorio, Jussi M. Kärkkäinen, Bernardo C. Mendes, Randall R. DeMartino

    We sought to evaluate the safety and efficacy of totally percutaneous femoral access (TPFA) for fenestrated–branched endovascular aortic repair (F/B-EVAR) of pararenal–thoracoabdominal aortic aneurysms (PRAs/TAAAs).

    更新日期:2020-01-15
  • Smartphone Augmented Reality CT-Based Platform for Needle Insertion Guidance: A Phantom Study
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2020-01-08
    Rachel Hecht, Ming Li, Quirina M. B. de Ruiter, William F. Pritchard, Xiaobai Li, Venkatesh Krishnasamy, Wael Saad, John W. Karanian, Bradford J. Wood

    Abstract Objective To develop and assess the accuracy of an augmented reality (AR) needle guidance smartphone application. Methods A needle guidance AR smartphone application was developed using Unity and Vuforia SDK platforms, enabling real-time displays of planned and actual needle trajectories. To assess the application’s accuracy in a phantom, eleven operators (including interventional radiologists, non-interventional radiology physicians, and non-physicians) performed single-pass needle insertions using AR guidance (n = 8) and CT-guided freehand (n = 8). Placement errors were measured on post-placement CT scans. Two interventional radiologists then used AR guidance (n = 3) and CT-guided freehand (n = 3) to navigate needles to within 5 mm of targets with intermediate CT scans permitted to mimic clinical use. The total time and number of intermediate CT scans required for successful navigation were recorded. Results In the first experiment, the average operator insertion error for AR-guided needles was 78% less than that for CT-guided freehand (2.69 ± 2.61 mm vs. 12.51 ± 8.39 mm, respectively, p < 0.001). In the task-based experiment, interventional radiologists achieved successful needle insertions on each first attempt when using AR guidance, thereby eliminating the need for intraoperative CT scans. This contrasted with 2 ± 0.9 intermediate CT scans when using CT-guided freehand. Additionally, average procedural times were reduced from 13.1 ± 6.6 min with CT-guided freehand to 4.5 ± 1.3 min with AR guidance, reflecting a 66% reduction. Conclusions All operators exhibited superior needle insertion accuracy when using the smartphone-based AR guidance application compared to CT-guided freehand. This AR platform can potentially facilitate percutaneous biopsies and ablations by improving needle insertion accuracy, expediting procedural times, and reducing radiation exposures.

    更新日期:2020-01-08
  • Comparison of Percutaneous Transluminal Angioplasty with Stenting for Treatment of Central Venous Stenosis or Occlusion in Hemodialysis Patients: A Systematic Review and Meta-analysis
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2020-01-03
    Tien-Yu Wu, Chung-Kuan Wu, Yen-Yang Chen, Chia-Hsun Lin

    A common cause of hemodialysis vascular access dysfunction, a primary cause of morbidity and mortality in patients undergoing hemodialysis, is central venous stenosis or occlusion. The present study compared percutaneous transluminal angioplasty (PTA) with percutaneous transluminal angioplasty and stent placement (PTS) for treatment of central venous stenosis or central vein occlusion in hemodialysis patients.

    更新日期:2020-01-04
  • Improvements in Irritative Versus Obstructive Symptoms of the International Prostate Symptom Score After Prostatic Artery Embolization in 174 Patients, in a Single Center
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2020-01-02
    Airton Mota Moreira, André Moreira de Assis, Francisco Cesar Carnevale, Daniel Simões Oliveira, Alberto Azoubel Antunes

    Abstract Aim The aim of this study is to compare the improvements in irritative versus obstructive symptoms of the International Prostate Symptom Score (IPSS) after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). Materials and Methods Between 2010 and 2018, 186 patients underwent PAE in a single center and 174 patients were retrospectively selected. The inclusion criteria were symptoms due to BPH, refractory to pharmacological treatment and IPSS ≥ 8. The mean age of the patients was 63.7 ± 7.2 years, the mean prostate volume 89.5 ± 42.5 cm3, and the mean IPSS 19.0 ± 6.2 points. Patient data were reviewed at baseline, 3, 12 and 24 months and compared using the ANOVA mixed models and the Tukey’s multiple comparison test. Results Obstructive subscores dropped more significantly than irritative subscores (p < 0.0001). The mean decrease in each IPSS item was frequency 2.4 (83%); urgency 0.8 (87%); nocturia 1.3 (49%); incomplete emptying 2.6 (83%); intermittency 2.3 (91%); weak stream 2.9 (82%); straining 1.6 (91%). The area under the curve for baseline obstructive scores was 0.7 (p = 0.006) and 0.59 (p = 0.182) for irritative scores. The most common BPH clinical manifestations include irritative and/or obstructive symptoms, the latter usually more prevalent. The IPSS drop observed after PAE suggests that it acts predominantly over obstructive symptoms (p < 0.0001). Conclusion Although a predominant improvement in obstructive symptoms may be observed after PAE, nocturia complaints may require special attention. The severity of baseline obstructive symptoms may significantly predict clinical outcomes.

    更新日期:2020-01-04
  • Fundamental Evaluation of Thermophysical Properties of Lipiodol Associated with Cryoablation: Freezing Experiments Using Lipiodol Phantom
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2020-01-02
    Tatsuya Yoshikawa, Hiroshi Miura, Tatsuya Hirota, Shunsuke Asai, Masanori Yamashita, Kei Yamada, Mohammed Shurrab, Takanobu Fukunaga, Hiroshi Takamatsu

    Abstract Purpose To elucidate the basic thermophysical properties at low temperatures of lipiodol, which is used as a marker by transarterial injection before CT-guided cryoablation for solid tumors, by fundamental experiments with pure lipiodol phantom. Materials and Methods The freezing point of lipiodol was measured using differential scanning calorimeter (DSC) by detecting differences in the heating rate during heating from − 30 °C. Freezing experiments were conducted using pure lipiodol and a tissue phantom, which were prepared in an acrylic container at 37 °C. The growth of the frozen region was observed for 10 min. Temperatures were monitored at the cryoprobe surface and designated positions around the cryoprobe. Results The DSC experiment showed that freezing was observed between − 5 and − 30 °C, which indicated that the freezing point was approximately − 5 °C. Freezing experiments revealed that the diameter of frozen region in the lipiodol was smaller than that in the tissue phantom (5 mm vs 24 mm) after 10-min freezing. The temperature at the probe surface was − 130 °C in lipiodol, which was 25 °C lower than that in the tissue phantom. There was a larger temperature gradient near the cryoprobe in lipiodol due to lower thermal conductivity. Conclusions The present results suggest that an extremely high concentration of lipiodol (close to pure lipiodol) potentially reduces frozen region because of its lower freezing point and smaller thermal conductivity. However, since lipiodol concentrations in clinical cases differ from the current model, further studies using models that are close to clinical conditions are required. Level of Evidence No level of evidence, laboratory investigation.

    更新日期:2020-01-04
  • Resection Plus Post-operative Adjuvant Transcatheter Arterial Chemoembolization (TACE) Compared with Resection Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2020-01-02
    Ya Ruth Huo, Michael Vinchill Chan, Christine Chan

    Abstract Purpose Multiple studies have demonstrated adjuvant transcatheter arterial chemoembolization (aTACE) after resection improved outcomes compared to resection alone for patients with hepatocellular carcinoma (HCC). Unlike pre-operative TACE which targets a lesion, aTACE is administered in the proximal hepatic artery to destroy cancer cells within the remaining liver. This systematic review and meta-analysis aims to quantify this survival and disease-free survival (DFS) benefit. Methods A search of five databases was performed from inception to 20 August 2019. Results A total of 26 studies (six randomized controlled trials) involving 7817 patients were included. Patients treated with resection plus aTACE had significantly better 1-year survival (OR, 2.53 [95% CI, 1.70–3.76, p < 0.001) and 1-year DFS (OR, 1.91 [95% CI, 1.60–2.28, p < 0.001) compared to resection alone. The survival benefit remained significant for 2- to 5-year survival (OR 2.39, 1.83, 2.12, 1.87, respectively) and 2- to 4-year DFS (OR 1.85, 1.24, 1.67, respectively). Subgroup analysis showed significant survival benefit with aTACE in microvascular invasion (MVI)-positive HCC, portal venous tumour thrombus (PVTT) that does not involve the main trunk, PVTT-negative, satellite nodules, with and without resection margin < 1 cm. No mortalities were reported with aTACE. Conclusion Post-operative aTACE is safe and improves overall and disease-free survival, with the greatest benefit in MVI-positive patients. The current evidence weakly supports the use of adjuvant TACE for patients without PVTT, with PVTT that does not involve the main trunk, with and without a resection margin < 1 cm, and patients with satellite nodules. Level of Evidence Level 1

    更新日期:2020-01-04
  • Correction to: Focus on Recommendations for the Management of Non-small Cell Lung Cancer
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-11-05
    Pernelle Lavaud, Benjamin Besse, Thierry de Baere, Frederic Deschamps, Sacha Mussot, Cécile Le Pechoux, Caroline Caramella, Olaf Mercier, Laura Mezquita, Angela Botticella, Pauline Pradere, Julien Adam, David Planchard, Lambros Tselikas

    The authors would like to apologize for the misspelling of one of the co-authors names.

    更新日期:2020-01-04
  • Long-Term Mortality of Matched Patients with Intermittent Claudication Treated by High-Dose Paclitaxel-Coated Balloon Versus Plain Balloon Angioplasty: A Real-World Study
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-09-09
    Konstantinos P. Donas, Anne Sohr, Georgios A. Pitoulias, Fernando Alfonso, Giovanni Torsello

    The aim of this study was to assess the long-term mortality of patients treated by the IN.PACT Admiral (Medtronic, Dublin, Ireland) paclitaxel-coated balloon angioplasty (PCBA) compared with standard plain balloon angioplasty (POBA).

    更新日期:2020-01-04
  • 68 Ga-PSMA-PET/CT and Diffusion MRI Targeting for Cone-Beam CT-Guided Bone Biopsies of Castration-Resistant Prostate Cancer Patients
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-08-23
    T. R. F. van Steenbergen, M. Smits, T. W. J. Scheenen, I. M. van Oort, J. Nagarajah, M. M. Rovers, N. Mehra, J. J. Fütterer

    Abstract Introduction Precision medicine expands the treatment options for metastatic castration-resistant prostate cancer (mCRPC) by targeting druggable genetic aberrations. Aberrations can be identified following molecular analysis of metastatic tissue. Bone metastases, commonly present in mCRPC, hinder precision medicine due to a high proportion of biopsies with insufficient tumor cells for next-generation DNA sequencing. We aimed to investigate the feasibility of incorporating advanced target planning and needle guidance in bone biopsies and whether this procedure increases biopsy tumor yield and success rate of molecular analysis as compared to the current standards, utilizing only CT guidance. Materials and Methods In a pilot study, ten mCRPC patients received 68Ga-prostate-specific membrane antigen (PSMA)-PET/CT and diffusion-weighted MRI as biopsy planning images. These datasets were fused for targeting metastatic lesions with high tumor densities. Biopsies were performed under cone-beam CT (CBCT) guidance. Feasibility of target planning and needle guidance was assessed, and success of molecular analysis and tumor yield were reported. Results Fusion target planning and CBCT needle guidance were feasible. Nine out of ten biopsies contained prostate cancer cells, with a median of 39% and 40% tumor cells by two different sequencing techniques. Molecular analysis was successful in eight of ten patients (80%). This exceeds previous reports on CT-guided biopsies that ranged from 33 to 44%. In two patients, important druggable aberrations were found. Discussion A biopsy procedure using advanced target planning and needle guidance is feasible and can increase the success rate of molecular analysis in bone metastases, thereby having the potential of improving treatment outcome for patients with mCRPC. Level of Evidence Level 4, case series.

    更新日期:2020-01-04
  • Percutaneous Transesophageal Access for Enteral Feeding Tube Placement
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-08-21
    Mamadou L. Sanogo, William Sherk, Anthony Esparaz, Xhorlina Marko, Joseph J. Gemmete, James Shields

    Abstract Background The purpose of this study was to describe our experience with percutaneous transesophageal enteral feeding tube placement when percutaneous gastrostomy tube placement is not feasible. Materials and Methods A retrospective review was performed from July 2018 to March 2019. Thirteen patients (9 females, 4 males), (age range 22–80 years; mean age, 55 years; mean body mass index of 24.6) underwent placement of 14 percutaneous transesophageal enteral feeding tubes. Relative contraindications to standard gastrostomy tube placement included: prior gastric surgery (5 patients), severe contractures/large body habitus (2), abdominal mesh (1), high riding stomach (1), interposition of bowel (1), ascites (1), and refractory gastrostomy tract leak (1). Patients were evaluated for functionality of the tube, complications, and patients’ satisfaction with physical examination at 24 h, review of electronic medical record and phone interviews at 1 month, and 3-month follow-up. Complications were classified according to the CIRSE guidelines. Results Technical success rate was 100% with placement of seven percutaneous transesophageal gastrostomy tubes and seven percutaneous transesophageal jejunostomy tubes. One patient underwent tube placement twice after dislodgement. At 3-month follow-up, two patients had died, one patient was lost to follow-up, and 11 patients had properly working tubes. No major complications occurred. Minor complication rate was 43% (6/14). Patient’s satisfaction scores ranged from “poor” 2/11 (18%) or “neutral” 4/11 (36.4%) to “satisfied/very satisfied” 5/11 (45.3%). Conclusion Percutaneous transesophageal enteral feeding tube placement is feasible with a low complication rate. A majority of patients were either satisfied or neutral with the transesophageal enteral tube.

    更新日期:2020-01-04
  • Percutaneous Fixation by Internal Cemented Screws of the Sternum
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-09-03
    Benjamin Poussot, Frederic Deschamps, Florent Varin, Abdelhai Abed, Benjamin Moulin, Clara Prud’homme, Marc Al Ahmar, Christophe Teriitehau, Antoine Hakime, Sophie Laurent, Thierry de Baere, Lambros Tselikas

    Abstract Purpose To evaluate the feasibility, efficacy and safety of sternal percutaneous fixation by internal cemented screw (FICS) using fluoroscopy and/or CT needle guidance. Materials and Methods This retrospective single-center study analyzed 9 consecutive cancer patients managed with percutaneous FICS for sternal fracture fixation or osteolytic metastasis consolidation, from May 2014 to February 2019. Eastern Cooperative Oncology Group performance status, Numeric Pain Rating Scale (NPRS) and opioid use were studied preoperatively and postoperatively. Sternal images at last follow-up appointment were also collected. Results Among the 9 patients, 7 had a sternal fracture with 5 being displaced. The technical feasibility was 100%. Both NPRS score significantly decreased from 5.6/10 ± 2.8 to 1.1/10 ± 1.6, and analgesic consumption was significantly improved (p = 0.03) after intervention. No post-procedural complications requiring surgical correction or screw displacement occurred after a mean imaging follow-up that exceeded 1 year (mean follow-up duration, 401.8 days ± 305.8). Conclusion Image-guided sternal percutaneous FICS is feasible and safe. It reduces pain and analgesic consumption related to pathologic fracture of the sternum.

    更新日期:2020-01-04
  • Percutaneous Intervertebral Disc Coagulation Therapy (PDCT) by Plasma Light: Preliminary Data from the First Experience in Europe
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-08-13
    Chiara Zini, Dario Notaro, Giulia Sadotti, Giacomo Zini, Lucia Monti, Matteo Bellini

    To retrospectively assess safety and potential effectiveness of percutaneous intervertebral disc coagulation therapy (PDCT) using plasma thermal reaction for the treatment of lumbar and cervical disc hernias resistant to medical therapy.

    更新日期:2020-01-04
  • Inferior Vena Cava Atresia: Characterisation of Risk Factors, Treatment, and Outcomes
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-10-24
    Tarub S. Mabud, Anna M. Sailer, Joshua K. Y. Swee, Mallika Tamboli, Victoria A. Arendt, Gyeong-Sik Jeon, Xiao An, David M. Cohn, William T. Kuo, Lawrence V. Hofmann

    To characterise (1) the risk factors associated with inferior vena cava (IVC) atresia, (2) the radiographic and clinical presentations of deep vein thrombosis (DVT) in patients with IVC atresia, and (3) the treatment and outcome of DVT in patients with IVC atresia.

    更新日期:2020-01-04
  • Percutaneous Microwave Ablation Versus Cryoablation in the Treatment of T1a Renal Tumors
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-08-26
    Francesco De Cobelli, Maurizio Papa, Marta Panzeri, Michele Colombo, Stephanie Steidler, Alessandro Ambrosi, Roberta Cao, Simone Gusmini, Paolo Marra, Umberto Capitanio, Roberto Bertini, Massimo Venturini, Andrea Losa, Franco Gaboardi, Francesco Montorsi, Gianpiero Cardone

    Abstract Purpose Radiofrequency and cryoablation (Cryo) are the most widely used techniques for the treatment of T1a renal tumors in non-surgical candidates, yet microwave ablation (MWA) has been gaining popularity. In this study, we tested the hypothesis that MWA has comparable safety and efficacy to Cryo in the treatment of selected T1a renal masses. Materials and Methods A retrospective comparative analysis of two patient cohorts was carried out on 83 nodules in 72 consecutive patients treated using image-guided percutaneous ablation with either Cryo or MWA. Patient demographics, tumor histology and characteristics, technical success, procedure time, adverse events and complications, nephrometry score (mRENAL) and renal function were evaluated. Local recurrence was evaluated at 1, 6, 12 and 18–24 months. Results Fifty-one nodules were treated with Cryo and 32 with MWA (44 and 28 patients, respectively). No statistical differences were observed following Cryo or MWA in median tumor size (p = 0.6), mRENAL (p = 0.1) or technical success (p = 0.8). Median procedure time was significantly lower using microwave ablation (p = 0.003). Median follow-up time was similar in the two groups (22 and 20 months, respectively). Occurrence of complications did not differ (Cryo 5/51, MWA 2/32; p = 0.57), and probability of complications or technical success adjusted for mRENAL did not reach statistical significance (p = 0.6). Renal function was preserved in all patients regardless of techniques. Disease recurrence was observed in 3/47 and in 1/30 treated nodules in the Cryo and MWA groups, respectively, without reaching statistical significance (p = 0.06). Conclusion In the patient population studied, MWA showed comparable safety and efficacy relative to Cryo. Level of Evidence Level 3, Non-randomized cohort study.

    更新日期:2020-01-04
  • Treatment of Recurrent Pulmonary Arteriovenous Malformations: Comparison of Proximal Versus Distal Embolization Technique
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-08-30
    Lucas R. Cusumano, Gary R. Duckwiler, Dustin G. Roberts, Justin P. McWilliams

    To examine the characteristics of recurrent pulmonary arteriovenous malformations (PAVMs) and compare the success of proximal versus distal embolization technique for treatment of recanalized PAVMs.

    更新日期:2020-01-04
  • Transarterial Chemoembolization of Hepatocellular Carcinoma: Propensity Score Matching Study Comparing Survival and Complications in Patients with Nonalcoholic Steatohepatitis Versus Other Causes Cirrhosis
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-11-04
    Shamar Young, Tina Sanghvi, Nathan Rubin, Damian Hall, Luke Roller, Yassine Charaf, Jafar Golzarian

    To evaluate the oncologic outcomes and complication profile in nonalcoholic steatohepatitis (NASH)-induced cirrhosis leading to hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE).

    更新日期:2020-01-04
  • Conventional Versus Small Doxorubicin-eluting Bead Transcatheter Arterial Chemoembolization for Treating Barcelona Clinic Liver Cancer Stage 0/A Hepatocellular Carcinoma
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-10-23
    Yang Jun Kang, Byung Chan Lee, Jae Kyu Kim, Nam Yeol Yim, Hyoung Ook Kim, Soo Buem Cho, Yong Yeon Jeong

    Approximately, 60–70% of patients with early-stage hepatocellular carcinoma (HCC) globally are ineligible for the recommended first-line procedures. This study aimed to compare conventional transcatheter arterial chemoembolization (cTACE) with a treatment, small drug-eluting bead TACE (DEB-TACE), in patients with stage 0/A HCCs.

    更新日期:2020-01-04
  • Efficacy of the tract embolization technique with gelatin sponge slurry to reduce pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Hadrien Renier,Laurent Gérard,Pierre Lamborelle,François Cousin

    PURPOSE To assess the efficacy of the tract embolization technique using gelatin sponge slurry after CT-guided lung biopsy to reduce pneumothorax and chest tube placement rates. MATERIALS AND METHODS We retrospectively compared 231 CT-guided lung biopsies performed with the tract embolization technique using gelatin sponge slurry (treated group) with 213 biopsies performed without embolization (control group). All procedures were performed at our institution between January 2014 and September 2018 by one of three experienced interventional radiologists using a 19-gauge coaxial needle. Multivariate analysis was performed between groups for risk factors for pneumothorax and chest tube placement, including patient demographics and lesion characteristics. RESULTS When comparing the two groups, there was no significant difference concerning age, gender, emphysema, lesion size, lesion location, lesion morphology, needle tract depth and biopsy-side down patient positioning. Compared to the control group, patients with gelatin sponge slurry tract embolization had statistically lower rates of pneumothorax (10% vs. 25.8%; p < 0.0001) and chest tube placement (3.5% vs. 12.2%; p = 0.0005). Using multiple logistic regression analysis, the only variable that had an influence on the pneumothorax rate was the group (OR 0.32, 95% CI 0.18-0.56, p < 0.0001), and the variables that had an influence on the chest tube insertion rates were the group (OR 0.21, 95% CI 0.08-0.51, p = 0.0006) and presence of emphysema (OR 3.50, 95% CI 1.53-8.03, p = 0.0031). CONCLUSIONS Tract embolization technique using gelatin sponge slurry after percutaneous CT-guided lung biopsy significantly reduces pneumothorax and chest tube placement rates. LEVEL OF EVIDENCE Level 3a.

    更新日期:2019-11-01
  • CIRSE Standards of Practice on Prostatic Artery Embolisation.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Francois H Cornelis,Tiago Bilhim,Nigel Hacking,Marc Sapoval,Charles R Tapping,Francisco Cesar Carnevale

    更新日期:2019-11-01
  • Continuous Injection of Large Volumes of Cement Through a Single 10G Vertebroplasty Needle in Cases of Large Osteolytic Lesions.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Julien Garnon,Laurence Meylheuc,Pierre Auloge,Guillaume Koch,Danoob Dalili,Roberto Luigi Cazzato,Bernard Bayle,Afshin Gangi

    更新日期:2019-11-01
  • Uterine Artery Embolisation for Women with Giant Versus Non-giant Uterine Fibroids: A Systematic Review and Meta-analysis.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Oliver Llewellyn,Neeral R Patel,Dermot Mallon,Stephen D Quinn,Mohamad Hamady

    BACKGROUND Evidence supporting uterine artery embolisation (UAE) for giant fibroids (≥ 10 cm and/or uterine volume ≥ 700 CC) remains sparse. We performed a systemic review and meta-analysis of UAE outcomes for symptomatic giant versus non-giant fibroids. METHODS The literature was systematically reviewed. Research studies of UAE as an adjunct to surgery, and those not using peri-operative MRI were excluded. Primary outcomes were fibroid size and uterine volume reduction, procedure time, length of hospital stay, reinterventions, patient symptom improvement/satisfaction and complications. RESULTS We identified four observational studies (839 patients; giant = 163, non-giant = 676). Both groups demonstrated reduction in fibroid size and uterine volume after UAE, with equivocal difference in uterine volume reduction (Mean difference (MD) - 0.3 95% confidence interval (CI) - 3.8 to 3.1, p = 0.86) and greater reduction in non-giant dominant fibroid size (MD - 5.9 95% CI - 10.3 to - 1.5, p < 0.01). Giant fibroids were associated with 5.6 min longer mean operative time (MD 5.6 min 95% CI 2.6-8.6, p < 0.01) and 4.8 h longer mean hospital stay (MD 4.8 h 95% CI 1.1-8.6, p = 0.01). Patient symptoms/satisfaction outcomes were summarised, but too heterogeneous for meta-analysis. Major complication and reintervention rates were low, with a statistically higher rate of major complications (Odds ratio (OR) 4.7 95% CI 1.5-14.6, p < 0.01) and reinterventions (OR 3.6 95% CI 1.7-7.5, p < 0.01) in giant fibroids. CONCLUSIONS Current evidence shows UAE is a safe and effective option to treat giant fibroids. However, the limited available data indicate a relatively higher risk of complications and reinterventions when compared with non-giant fibroids. Patients should be selected, counselled and managed accordingly. LEVEL OF EVIDENCE Level III, Systematic review of retrospective cohort studies.

    更新日期:2019-11-01
  • MR-Guided Percutaneous Intradiscal Thermotherapy (MRgPIT): Evaluation of a New Technique for the Treatment of Degenerative Disc Disease in Cadaveric Lumbar Spine.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    T Leidenberger,A Winkel,C Philipp,J Rump,M De Bucourt,G Böning,U Teichgräber,F Streitparth

    PURPOSE Evaluation of MR feasibility and real-time control of an innovative thermoablative applicator for intradiscal thermotherapy and histological analysis of laser annuloplasty in human ex vivo intervertebral discs. MATERIALS AND METHODS We evaluated a new MR-compatible applicator system for MR-guided percutaneous intradiscal thermotherapy (MRgPIT) in an open 1.0-T MRI-system. Needle artefacts and contrast-to-noise ratios (CNR) of six interactive sequences (PD-, T1-, T2w TSE, T1-, T2w GRE, bSSFP) with varying echo-times (TE) and needle orientations to the main magnetic field (B0) were analysed. Additionally, five laser protocols (Nd: YAG Laser, 2-6 W) were assessed in 50 ex vivo human intervertebral discs with subsequent histological evaluation. RESULTS In vitro, we found optimal needle artefacts of 1.5-5 mm for the PDw TSE sequence in all angles of the applicator system to B0. A TE of 20 ms yielded the best CNR. Ex vivo, ablating with 5 W induced histological denaturation of collagen at the dorsal annulus, correlating with a rise in temperature to at least 60 °C. The MRgPIT procedure was feasible with an average intervention time of 17.1 ± 5.7 min. CONCLUSION Real-time MR-guided positioning of the MRgPIT-applicator in cadaveric intervertebral disc is feasible and precise using fast TSE sequence designs. Laser-induced denaturation of collagen in the dorsal annulus fibrosus proved to be accurate.

    更新日期:2019-11-01
  • Endovascular Management of Acquired Hepatic Arterial-Portal Venous Malformations.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Ahsun Riaz,Robert Vogelzang,Victoria Young,Ahmed Gabr,Daniel Ganger,Michael Abecassis,Robert J Lewandowski,Bartley Thornburg,Riad Salem,Krassi Ivancev,Scott Resnick

    PURPOSE Arteriovenous malformations (AVMs) are typically congenital in origin, but acquired types, such as dural arteriovenous fistula (AVF), have been described. This study aimed to describe the diagnosis and endovascular treatment of acquired hepatic arterial-portal venous (HA-PV) malformations. MATERIALS AND METHODS A retrospective review of suspected acquired HA-PV malformations from 9/2011 to 2/2018 was performed. Eight patients (1M:7F, average age 62) with HA-PV malformations were identified. Four (50%) patients had a history of liver transplant. All HA-PV malformations were Yakes type IIIA (multiple inflow arteries with a single vein outflow and with the nidus located within the vein wall). In all cases, computed tomography angiography/magnetic resonance angiography was unable to distinguish AVMs from AVFs, and a wrong diagnosis was made in each instance. RESULTS Review of pre-procedural Doppler ultrasounds in all cases demonstrated arterialization of portal vein waveforms. Review of pre-procedural cross-sectional (CT/MR) imaging in all of these cases demonstrates a network of arteries around the portal vein with early portal vein filling in every instance. Attempts to close the shunts via arterial inflow embolization but without venous nidus occlusion were performed and were unsuccessful in five out of eight (62.5%) cases. All curative therapies were via embolization of the outflow vein (segmental or lobar portal vein). Technical success was seen in seven of eight cases (87.5%), while one patient is planned to receive additional nidal vein embolization. Liver function was preserved after treatment without worsening of bilirubin or albumin levels. CONCLUSION The diagnosis of an acquired HA-PV malformation can guide curative endovascular treatment by embolization of the portal vein outflow.

    更新日期:2019-11-01
  • Periprocedural Heparin During Endovascular Treatment of Tandem Lesions in Patients with Acute Ischemic Stroke: A Propensity Score Analysis from TITAN Registry.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-06-04
    François Zhu,Michel Piotin,Henrik Steglich-Arnholm,Julien Labreuche,Markus Holtmannspötter,Christian Taschner,Sebastian Eiden,Diogo C Haussen,Raul G Nogueira,Panagiotis Papanagiotou,Maria Boutchakova,Adnan H Siddiqui,Bertrand Lapergue,Franziska Dorn,Christophe Cognard,Monika Killer-Oberpfalzer,Salvatore Mangiafico,Marc Ribo,Marios N Psychogios,Alejandro Spiotta,Mohammad Anadani,Marc-Antoine Labeyrie,Mikael Mazighi,Alessandra Biondi,Sébastien Richard,René Anxionnat,Serge Bracard,Francis Turjman,Benjamin Gory,

    BACKGROUND AND PURPOSE Data on safety and efficacy of periprocedural use of heparin are limited during treatment of acute ischemic stroke patients with anterior circulation tandem occlusion. This study aimed to investigate the impact of heparin use during endovascular therapy of anterior circulation tandem occlusions on the functional and safety outcomes. METHODS A retrospective analysis of the multicenter observational TITAN registry was performed. Patients with anterior circulation tandem occlusion and treated with endovascular therapy (EVT) were included, with or without extracranial carotid intervention. We divided patients into two groups based on periprocedural heparin use (heparin vs. non-heparin). The dose of intravenous unfractionated heparin ranged from 1500 to 2500 I.U. Primary study endpoint was 90-day Modified Rankin Scale (mRS). Secondary study endpoint included angiographic and safety endpoints such as hemorrhagic complications. A propensity-score-matched analysis was performed. RESULTS Among 369 patients, heparin was used in 68 patients (18.4%). In the propensity-score-matched cohort, favorable outcome (mRS 0-2) occurred in 51.3% in heparin group and 58.0% in non-heparin group (matched OR, 0.76; 95% CI, 0.32-1.78; P = 0.52). Similar result was found in propensity-score-adjusted cohort (adjusted OR, 0.72; 95%CI, 0.39-1.32; P = 0.28). Likewise, there was no difference in the rate of successful reperfusion (mTICI 2b-3) (propensity-score-adjusted OR, 1.03; 95%CI, 0.50-2.09; P = 0.93) neither in safety endpoints between the two groups. CONCLUSIONS Periprocedural heparin use during EVT of anterior circulation tandem occlusions was not associated with better functional, angiographic or safety outcomes. These findings are applicable for low doses of heparin, and further studies are warranted.

    更新日期:2019-11-01
  • A New Fully Covered Irradiation Stent Versus a Partially Covered Irradiation Stent for Unresectable Malignant Dysphagia: A Single-Center Experience.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-31
    Chao Wang,Jian Lu,Yong Wang,Guang-Yu Zhu,Li Chen,Jun-Chao Li,Tian-Kuan Li,Lei Chen,Jin-He Guo

    PURPOSE To assess the efficacy and safety of a newly developed fully covered irradiation stent (FCIS) compared with a partially covered irradiation stent (PCIS) in patients with unresectable malignant dysphagia. MATERIALS AND METHODS Data of 195 patients [158 (81.0%) males, median age of 75 years (range 49-89 years)] who underwent FCIS or PCIS placement for unresectable malignant dysphagia from January 2012 to November 2017 were retrospectively analyzed. The median follow-up time was 181 days (range 4-547 days). Outcomes were measured in terms of recurrent dysphagia (primary), technical success, clinical success, overall survival, and adverse events. Recurrent dysphagia was analyzed by Fine-Gray regression model. RESULTS The technical success rate was 97.8% (87/89) in the FCIS group and 99.1% (105/106) in the PCIS group (P = 0.59). The clinical success rate was 100.0% in both groups. There was no statistically significant difference in the recurrent dysphagia rate between the FCIS and PCIS groups (21.8% vs. 28.6%; P = 0.12). Compared with PCISs, FCISs were associated with a decrease in tissue/tumor growth rate (11.5% vs. 21.9%; P = 0.01), while stent migration rates were statistically comparable (11.5% vs. 5.7%; P = 0.23). The median overall survivals were comparable between the FCIS and PCIS groups (164 days vs. 162 days; P = 0.70). A dysphagia score of 4 and metastasis were risk factors for survival. No significant differences were observed in the rates of adverse events, including chest pain, fistula formation, hemorrhage, and aspiration pneumonia (P > 0.05). CONCLUSION For patients with unresectable malignant dysphagia, this newly developed FCIS can provide efficacy and safety comparable to those of a PCIS. Compared with PCIS, this FCIS is more successful in preventing tissue/tumor growth, with a comparable stent migration rate.

    更新日期:2019-11-01
  • The Safety of Continuing Therapeutic Anticoagulation During Inferior Vena Cava Filter Retrieval: A 6-Year Retrospective Review from a Tertiary Centre.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-30
    Rahil H Kassamali,Kateryna Burlak,Jonathan T L Lee,Georgina Aberdein,George Harisis,Gerard S Goh,Helen Kavnoudias,Warren Clements

    PURPOSE Assess the safety of inferior vena cava (IVC) filter retrieval in patients taking anticoagulation, compared to a non-anticoagulated cohort. MATERIALS AND METHODS Single-centre retrospective analysis of patients who underwent IVC filter retrieval between January 2012 and February 2018. Information about patient demographics, anticoagulation, tilt, major and minor complications was collected. Major complications were defined as: IVC injury from the filter retrieval, retained fragment of filter, filter fracture and filter embolisation. Minor complications were defined as: neck haematoma and puncture site infection. RESULTS Total of 357 patients (age 18-95, Male: 231) underwent IVC filter retrieval, comprising of Cook Celect Platinum, Cook Celect, and ALN-branded filters. Of these 182 patients were on anticoagulation and 175 patients were not on anticoagulation, based on the indication for the filter (thrombosis or prophylaxis) and at the discretion of the referring unit who were managing the anticoagulation. IVC filter retrieval was technically successful in 349 patients. Five major complications (1.4% of retrievals) were recorded and no minor complications (0% of retrievals). In the anticoagulation cohort, there were two major complications (1.1% of retrievals) both related to IVC injury. In the non-anticoagulated cohort, there were three major complications (1.7% of retrievals) relating to filter embolisation, IVC injury, and filter fracture. CONCLUSIONS IVC filter retrieval is a safe procedure with a low complication rate. Being on anticoagulation does not increase the risk of a major complication or change the management of major complication compared with a non-anticoagulated cohort. IVC filter retrieval is safe to perform in patients currently taking prophylactic or therapeutic anticoagulation based on our cohort. LEVEL OF EVIDENCE Level 3, retrospective cohort study.

    更新日期:2019-11-01
  • Percutaneous Treatment of Giant Cystic Echinococcosis in Liver: Catheterization Technique in Patients with CE1 and CE3a.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-24
    Omur Balli,Gulden Balli,Volkan Cakir,Serkan Gur,Ridvan Pekcevik,Cengiz Tavusbay,Okan Akhan

    PURPOSE This study aimed to evaluate the efficacy, safety, and follow-up results of the percutaneous treatment of cystic echinococcosis (CE) patients with giant hepatic cysts (at least one diameter > 10 cm). METHODS Between January 2013 and 2018, 31 CE patients with 34 giant cysts classified as CE1 or CE3a (Gharbi type 1 or 2) according to the World Health Organization criteria and treated with the catheterization technique were analyzed retrospectively. RESULTS Thirty-four giant hepatic cysts were treated using the catheterization technique. Technical success was 100%. One procedure was sufficient for 27 of these cysts, while six patients underwent a second procedure due to recurrence, recollection or complications; one did not accept a repeat procedure and decided to refer to surgery due to pain. Ten (29%) major complications developed. The overall clinical success was 97%. The mean follow-up period was 20 months (5-61 months), and the total reduction in the cyst volume was 92%. CONCLUSION The catheterization technique is effective in treating giant CE with acceptable complication rates. LEVEL OF EVIDENCE Level 4, Clinical Investigation.

    更新日期:2019-11-01
  • Inferior Vena Cava Filters in Hemodynamically Unstable Patients with Acute Pulmonary Embolism: How Often are They Used? Data from Multicenter Prospective Registries on Acute Pulmonary Embolism.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-17
    Marco Zuin,Gianluca Rigatelli,Pietro Zonzin,Loris Roncon

    The use of inferior vena cava (IVC) filters is recommended in patients with acute pulmonary embolism (PE) who have absolute contraindications to anticoagulant drugs and/or in those subjects with recurrent PE despite treated with an adequate anticoagulant regimen. During the last 2 decades, some investigations have demonstrated that the use of IVC filters in high-risk PE patients, treated or not with systemic thrombolysis, was able to reduce the short-term mortality rate if inserted early after the acute event. The aim of the present review is to analyze the use of IVC filters in high-risk PE patients enrolled in prospective multicenter registries between 1990 and 2018. After screening 3542 article in PubMed, Scopus, Cochrane library and Goggle Scholar databases, we identified four registry studies meeting the inclusion criteria. In a prospective cohort of 39,056 patients, 1387 (3.5%) were hemodynamically unstable at admission. Among them, IVC filters were used only in 2.7% of cases. Conversely, IVC filters were inserted in 3.8% of hemodynamically stable patients. Over the years, a fluctuating trend in the use of IVC filters was observed. In the absence of randomized controlled trial on this issue, which would be difficult, if not impossible to realize, data obtained from the medical literature seem to suggest that IVC filters could represent a valid adjunctive therapy in hemodynamically unstable PE patients, able to prevent further hemodynamic deterioration. Further and larger subgroup analyses, obtained both by prospective and retrospective studies, are necessary to clarify this therapeutic approach.

    更新日期:2019-11-01
  • Distal Edge Stenosis After Stent Placement for Isolated Superior Mesenteric Artery Dissection: Mechanisms and Risk Factor Analysis.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-17
    Cheng Hang,Wenhua Chen,Haobo Su,Zhongzhi Jia,Chunjian Qi,Jianping Gu

    PURPOSE To analyze factors potentially associated with the occurrence of distal edge stenosis after stent placement for isolated superior mesenteric artery dissection (ISMAD). MATERIALS AND METHODS Cases of consecutive patients who were diagnosed with spontaneous ISMAD between February 2010 and July 2018 were retrospectively identified. Of the 123 cases identified, 45 patients (42 men; three women) underwent endovascular stent placement and were included in the study. Univariate and multivariate analyses were used to assess factors potentially associated with distal edge stenosis. RESULTS The technical success rate among study patients was 100%. During 26.7 ± 17.3 months of follow-up, CT angiography demonstrated good distal edge patency in 25 patients (55.6%) and evidence of distal edge stenosis in 20 patients (44.4%). In univariate analysis, stent length (odds radio [OR] 1.03; 95% confidence interval [CI] 1.01, 1.06; P = .02), stent-to-vessel (S/V) diameter ratio (OR 2.27; 95% CI 1.35, 3.82; P < .01), and angulation at the distal edge (OR 1.05; 95% CI 1.00, 1.10; P =.03) were significantly associated with distal edge stenosis; only S/V diameter ratio (OR 3.36; 95% CI 1.41, 7.99; P < .01) and angulation at the distal edge (OR 1.12; 95% CI 1.01, 1.23; P =.03) retained this significance in multivariate analysis. CONCLUSIONS Distal edge stenosis after stent placement for ISMAD is common. S/V diameter ratio and angulation at the distal edge are independent risk factors for distal edge stenosis in patients with ISMAD who undergo stent placement.

    更新日期:2019-11-01
  • Accuracy of Length of Virtual Stents in Treatment of Intracranial Wide-Necked Aneurysms.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-12
    Kengo Nishimura,Katharina Otani,Ashraf Mohamed,Chihebeddine Dahmani,Toshihiro Ishibashi,Ichiro Yuki,Shogo Kaku,Hiroyuki Takao,Yuichi Murayama

    BACKGROUND AND PURPOSE Precise stent deployment is important for successful treatment of intracranial aneurysms by stent-assisted coiling (SAC). We evaluated the accuracy of virtual stents generated using commercial stent planning software by comparing the length of virtual and actually deployed intracranial laser cut stents on three-dimensional digital subtraction angiography (3D-DSA) images. METHODS We retrospectively analyzed the data of 75 consecutive cases of intracranial wide-necked aneurysms treated with the SAC technique using laser cut stents. Based on 3D-DSA images acquired by C-arm CT, stent sizing and placement were intraoperatively simulated by a commercial software application. The difference in length of the stents was estimated by measuring proximal discrepancies between the end points of the virtual and actually deployed stents on fused pre-procedural and post-procedural 3D-DSA images. Discrepancies between distal stent end points were manually minimized. The Kruskal-Wallis test was applied to test whether stent location, type, and length had an effect on difference in length between virtual and real stent. RESULTS The median difference in length between virtual and real stents was 1.58 mm with interquartile range 1.12-2.12 mm. There was no evidence for an effect of stent location (p = 0.23), stent type (p = 0.33), or stent length (p = 0.53) on difference in length between virtual and real stents. CONCLUSIONS Stent planning software allows 3D simulation of laser cut stents overlain on 3D-DSA images of vessels and may thus be useful for stent selection and deployment of laser cut stents during stent-assisted coiling of intracranial aneurysms.

    更新日期:2019-11-01
  • Usefulness of a Pretreatment CT-Based Modified RENAL Nephrometry Score in Predicting Renal Function After Cryotherapy for T1a Renal Mass.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-11
    Yoshiki Asayama,Akihiro Nishie,Yasuhiro Ushijima,Daisuke Okamoto,Koichiro Morita,Seiichiro Takao,Daisuke Kakihara,Keisuke Ishimatsu,Kousei Ishigami,Nobuhiro Fujita,Hiroshi Honda

    PURPOSE We investigated the usefulness of the modified RENAL nephrometry (mRN) scoring system for predicting post-cryotherapy renal function in patients with T1a renal mass. PATIENTS AND METHODS A total of 75 patients with a T1a renal mass were enrolled. The mRN score was determined based on the tumor size, the tumor's exophytic/endophytic properties, the tumor's nearness to the collecting system, and the anterior/posterior location of the kidney. The change in the estimated glomerular filtration rate (ΔeGFR) was calculated as follows: ΔeGFR = 100 × ([pretreatment eGFR - eGFR at 6 months after cryotherapy]/pretreatment eGFR). Based on the ΔeGFR results, we classified the patients into two groups: a preserved renal function group (ΔeGFR < 10%) and an impaired renal function group (ΔeGFR ≥ 10%). We then analyzed the relationships between the mRN score and ΔeGFR and between the mRN score and the chronic kidney disease (CKD) stage. RESULTS The mean ΔeGFR for all patients was 5.5%. The mRN scores of the preserved renal function group (5.8 ± 0.3) were significantly lower than those of the impaired group (7.4 ± 0.3) (p < 0.001). When the mRN score cutoff value was set at 7 points, the mRN had 67.7% sensitivity, 72.7% specificity, 61.8% positive predictive value (PPV), 76.1% negative predictive value (NPV), and 70.7% accuracy for predicting impaired renal function. For predicting a deterioration of CKD stage, the mRN had 92.9% sensitivity, 67.2% specificity, 39.4% PPV, 97.6% NPV, and 72% accuracy. CONCLUSION Our newly proposed modified RENAL nephrometry score was suggested to be useful for predicting renal function after renal cryotherapy.

    更新日期:2019-11-01
  • Incidence and Consequence of Nontarget Embolization Following Bland Hepatic Arterial Embolization.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-11
    Brandon J Newgard,George I Getrajdman,Joseph P Erinjeri,Anne M Covey,Lynn A Brody,Constantinos T Sofocleous,Karen T Brown

    PURPOSE Estimate the incidence of nontarget embolization (NTE) as identified on immediate post-hepatic artery embolization CT. MATERIALS AND METHODS Two hundred hepatic embolizations performed with particles alone (bland embolization) in 147 patients between August 16, 2013 and August 26, 2014 with immediate post-procedure CT were retrospectively reviewed. Arterial anatomy, vessels treated, imaging findings of NTE, patient demographics, length of hospital stay following embolization, and procedure-related complications were recorded. The data were analyzed using two-sided t-tests and chi-squared tests. RESULTS Evidence of NTE was seen on post-procedure CT in 64 of 200 cases (64/200, 32%). Six organs were affected, with 69 discrete sites in 64 patients. The majority (49/69, 71.0%) involved the gallbladder. The mean length of hospital stay (LOS) for patients with and without NTE was 2.9 ± 1.5 nights (range 1-7) and 2.9 ± 2.3 nights (range 0-21), respectively (P = 0.81). NTE was more common following embolization of replaced or accessory hepatic vessels. There were three complications in the NTE group (3/64, 4.7%) following the embolization procedure, one of which was cholecystitis directly related to NTE. The other two were one incidence each of contrast-induced nephropathy and pneumonia. In the group without NTE, seven complications occurred (7/136, 5.1%, P = 0.889), including one death resulting from hepatic failure, two gastrointestinal bleeds, two hepatic abscesses, flash pulmonary edema, and pancreatitis. CONCLUSION Unanticipated NTE is not uncommon after bland hepatic artery embolization, particularly after treating accessory or replaced vessels, but does not increase complications or LOS. LEVEL OF EVIDENCE Level 2b, Retrospective Cohort.

    更新日期:2019-11-01
  • Transhepatic Tract Embolisation After Biliary Intervention Using n-Butyl Cyanoacrylate and Autologous Blood: A Retrospective Analysis of 42 Patients.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-11
    Jung Min Hwang,Jong Hyun Byeon,Dong Jae Shim,Sun Ki Kim,Yu Ri Shin,Ki Jun Kim

    PURPOSE We evaluated the safety and efficacy of transhepatic tract embolisation after a biliary intervention using n-butyl cyanoacrylate (NBCA) and autologous blood. MATERIALS AND METHODS Between January 2017 and December 2018, 42 consecutive patients (mean age: 71 ± 15 years, 24 men) with malignant (n = 26) or benign (n = 16) biliary obstructions underwent percutaneous biliary intervention followed by tract embolisation within 2 weeks. Forty-six transhepatic tracts (4 bilateral) in 42 patients were embolised using a NBCA and lipiodol mixtures (1:1-1:2 ratios) after intraductal infusion of peripherally obtained autologous blood. The indwelling catheter diameters were 8.5-14 Fr. The median interval between percutaneous biliary drainage and tract embolisation was 10 days (range 3-14 days). Glue-cast formation via fluoroscopy and immediate complications were reviewed retrospectively in medical records. Follow-up data (median: 135, range 11-720 days) including computed tomography (CT) images (n = 17) were evaluated for delayed complications and glue-cast formation. RESULTS Successful glue-cast formations were achieved in all 46 tracts. No patients experienced haemorrhage, and only one patient had external bile leakage. Eight patients complained of abdominal pain (numerical scale ≤ 5) immediately after embolisation, which was controlled by analgesics. Two patients had transient fever. Segmental (n = 11) or sub-segmental (n = 6) glue-cast patterns were identified along the transhepatic tract by follow-up CT. No biliary obstructions were caused by inadvertent glue spread. Fragmented glue was detected outside the stent in one patient. CONCLUSION Transhepatic parenchymal tract embolisation with NBCA and autologous blood is a safe and feasible method for preventing bile leakage. LEVEL OF EVIDENCE Level 4, Case Series.

    更新日期:2019-11-01
  • Intraabdominal Hemorrhage from Ruptured Ectopic Varices Treated by Antegrade Embolization via a Recanalized Paraumbilical Vein.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-11
    Genki Fukumoto,Hiroyuki Kimura,Mitsunori Kanagaki,Shojiro Oka,Hiroki Tanaka,Yang Wang,Hiroaki Tanaka,Yuki Yamauchi,Toshiyuki Kimura

    A 49-year-old man with alcoholic liver cirrhosis was admitted to our hospital with abdominal pain. Contrast-enhanced CT demonstrated massive hemorrhagic ascites and ectopic varices fed by right colic and ileocolic veins. The varices were treated with selective embolization via a recanalized paraumbilical vein using N-butyl cyanoacrylate. Currently, no complications and rebleeding have occurred for 7 months. Antegrade embolization via a recanalized paraumbilical vein is feasible and less-invasive in a patient with massive ascites. Flow reduction may be effective for intraabdominal hemorrhage from ruptured ectopic varices. LEVEL OF EVIDENCE: Level 5, case report.

    更新日期:2019-11-01
  • Endovascular Treatment of Post-thrombotic Venous Ilio-Femoral Occlusions: Prognostic Value of Venous Lesions Caudal to the Common Femoral Vein.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-08
    Caroline Menez,Mathieu Rodiere,Julien Ghelfi,Christophe Seinturier,Thomas Martinelli,Bernard Imbert,Romain Perolat,Pierre Bouzat,Sophie Blaise,Patrick Carpentier,Gilles Pernod,Frédéric Thony

    OBJECTIVES To propose a scale of severity for post-thrombotic venous lesions (PTVLs) after ilio-femoral deep venous thrombosis and to compare the grade with the results of endovascular treatment of ilio-femoral PTVLs. METHODS In this retrospective monocentric observational study, we included 95 patients treated for ilio-femoral PTVLs. We proposed a four-grade scale evaluating the severity of PTVLS caudal to the common femoral vein based on CT phlebography and per-operative phlebography. For most patients, venous patency was assessed with color duplex ultrasonography and the clinical efficacy of the intervention using the Villalta and CIVIQ scores. RESULTS Recanalization was successful in 100% of patients with a morbidity rate of 4%. After a mean follow-up of 21 months, the overall primary patency was 75%, the assisted primary patency 82%, and the secondary patency 93%. Secondary patency was 100% for grade 0-1, 90% for grade 2, and 63% for grade 3 (p < 0.002). There was no correlation between the extension of stenting caudally of the common femoral vein and venous patency. The mean improvements in the Villalta and CIVIQ-20 scores were, respectively, 4.6 (p < 0.0001) and 18 (p < 0.0001); scores were not correlated with the grade of PTVLs in the thigh. CONCLUSION Venous patency after endovascular treatment of ilio-femoral PTVLs was strongly linked to the severity of PTVLs caudal to the common femoral vein but not to the extent of stenting.

    更新日期:2019-11-01
  • Experimental Assessment of a Novel Touchless Interface for Intraprocedural Imaging Review.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-03
    John Chung,David M Liu

    PURPOSE To examine the feasibility of a novel technology platform that enables real-time touchless interaction with radiology images in both a simulated and an actual clinical setting. MATERIALS AND METHODS This platform offers three different modes for image interaction. The gesture recognition mode uses a depth camera to detect the user's hand gestures which are translated to image manipulation commands. The light projection mode uses the same camera to detect finger point-and-tap movements above the icons which are projected on a surface to activate the commands. The capacitive sensing mode is enabled by a handheld, portable device, over which finger movements are detected by capacitive sensors to control the image review. Following initial feedback, light projection and capacitive sensing modes were selected for further testing by comparing with the conventional mode of image interaction in time trials for performing a series of standardized image manipulation tasks. Finally, the usability of the technology platform was examined in actual clinical procedures. RESULTS The light projection and the capacitive sensing modes were evaluated in the time trials and exhibited 60% and 71% reduction in time, respectively, relative to the control mode (p < 0.001). Clinical feasibility for this platform was demonstrated in three actual interventional radiology cases. CONCLUSION Accessing, navigating, and extracting relevant information from patient images intraprocedurally are cumbersome and time-consuming tasks that affect safety, efficiency, and decision-making during image-guided procedures. This study demonstrated that the novel technology addressed this issue by allowing touchless interaction with these images in the sterile field.

    更新日期:2019-11-01
  • Characterization of Calibrated Gelatin Sponge Particles in a Rabbit Renal Embolization Model.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-05-03
    Yongsheng Ye,Yimin Ren,Hanqiang Zeng,Jianxun He,Zhiwei Zhong,Xiaomei Wu

    PURPOSE To evaluate the level of artery occlusion, degradation periods, tissue response and vessel recanalization of calibrated gelatin sponge particles after segmental renal artery embolization. MATERIALS AND METHODS Superselective embolization of 14 adult rabbits was performed with calibrated gelatin sponge particles (150-350 μm). Two rabbits were killed immediately after the procedure (day 0). One pair of rabbits was killed on each of the following days: 1, 3, 7, 14, 28 and 56. One rabbit from each pair underwent CT angiography before embolization and killing. The pathologic changes of the embolized renal parenchyma and embolic characteristics of calibrated gelatin sponge particles were evaluated histologically and angiographically. RESULTS Calibrated gelatin sponge particles were distally located in interlobular artery with a dense packing on day 0. The level of occlusion paralleled the size of the particles. Partial degradation of the particles was observed on day 3, and complete degradation was observed on day 14. Vessel recanalization was observed through both CTA and histological analysis starting on day 3. Vascular inflammation responding to gelatin sponge particles was mild and subsided with the degradation of the particles. On day 28 and day 56, attenuation of embolized vessels occurred due to marked intimal proliferation, and vascular occlusion developed. CONCLUSIONS Gelatin sponge particles of 150-350 μm produced dense and distal embolization, and were resorbed before day 14 with a mild tissue reaction. Vessel recanalization occurred secondary to the resorption of gelatin sponge particles, but permanent vascular occlusion developed due to marked intimal hyperplasia after day 28.

    更新日期:2019-11-01
  • In Vivo Feasibility of Arterial Embolization with Permanent and Absorbable Suture: The FAIR-Embo Concept.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-04-27
    V Vidal,J F Hak,P Brige,S Chopinet,F Tradi,M Bobot,P Gach,A Haffner,G Soulez,A Jacquier,G Moulin,J M Bartoli,B Guillet

    PURPOSE Arterial embolization has been shown to be effective and safe for the management of bleeding, especially for postpartum and pelvic traumatic bleeding. We propose to evaluate the proof of concept of feasibility and effectiveness of arterial embolization with absorbable and non-absorbable sutures in a porcine model. MATERIALS AND METHODS In the acute setting (n = 1), several different arteries (mesenteric, splenic, pharyngeal, kidney) were embolized using non-absorbable sutures (NAS): Mersutures™ braided sutures (polyethylene terephthalate). In the chronic setting (n = 3), only lower pole renal arteries were embolized. On the right side, NAS was used, whereas on the left side embolization was realized with absorbable suture (AS): Vicryl® braided suture (polyglactin 910). The chronic group was followed for 3 months. The pigs received contrast-enhanced CT the day before embolization (D-1), after the embolization (D0), at 1 month and 3 months after embolization (M1 and M3); digital subtraction angiography (DSA) was done at D0 and M3 and histological analysis at M3. RESULTS All vascular targets were effectively embolized without any pre- or postoperative complications. Both DSAs and CTs at M3 showed a 100% recanalization rate for the AS embolization and a partial reversal rate for the NAS embolization. A renal hypotrophy in the embolized region was observed during both the M1 and M3 scans for both sutures (AS and NAS) with a clear hypotrophy for the NAS embolized kidney. CONCLUSION Embolization by AS and NAS (FAIR-Embo) is a feasible and effective treatment which opens up the possibility of global use of this inexpensive and widely available embolization agent.

    更新日期:2019-11-01
  • Prediction of Limb Salvage Following Percutaneous Vascular Intervention Using a Composite Tibial Artery Perfusion Score.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-04-20
    Harrison X Bai,Andrew J O Davis,Mark P Mantell,Michael A Troiano,Aaron W Brandis,Jonas R B Redmond,Timothy W I Clark

    PURPOSE To assess a novel tibial artery perfusion score (TPS) for predicting limb salvage in critical limb ischemia (CLI) patients undergoing percutaneous vascular intervention (PVI). PATIENTS AND METHODS A consecutive cohort of 115 CLI patients undergoing PVI in 144 limbs from 2011 to 2016 was analyzed. TPS comprised a 27-point scale based on: (1) patent tibial vessels following PVI, (2) severity of calcification of the tibial arteries, (3) presence of an intact pedal arch following intervention, (4) whether or not revascularization was direct or indirect based on the target angiosome, (5) presence of angiosome blush at the completion of index intervention. Limbs were stratified into (1) High [21-27 points], (2) Medium [13-20 points], and (3) Low [0-12 points] TPS. Predictive value of TPS was evaluated using logistic regression and Cox proportional hazards models. RESULTS The median follow-up was 15.7 months (range 0.4-69.9 months). Limb salvage in High, Medium, and Low TPS groups was 90.6%, 85.9%, and 55.6%, respectively, as freedom from the composite outcome: (1) limb complication resulting in death, (2) tibial bypass surgery, (3) above-the-knee amputation, or (4) below-the-knee amputation in patients without supratibial disease at the time of PVI. TPS was significantly associated with limb salvage defined as freedom from both the composite outcome and major amputation. CONCLUSIONS Based on this preliminary investigation, TPS was associated with limb salvage in CLI limbs, particularly in high-risk limbs. Further validation in a prospective cohort may identify patients with high-risk limbs in need of closer surveillance and earlier reintervention. LEVEL OF EVIDENCE Level IV, case series.

    更新日期:2019-11-01
  • Clinical and CT Angiographic Follow-Up Outcome of Spontaneous Isolated Intramural Hematoma of the Superior Mesenteric Artery.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-04-06
    Z Xiaoq,M Hao,L Lin,Y Jiao,J Zou,X Zhang,Y Y Hong

    OBJECTIVES The aim of this study was to evaluate the clinical course and vascular remodeling of spontaneous isolated intramural hematoma of the superior mesenteric artery (SIHSMA) after treatment. METHODS In this retrospective study, 24 consecutive patients with SIHSMA admitted from January 2009 through December 2016 were included in this study. The clinical characteristics, type and location of the dissection, clinical outcome and vascular remodeling were analyzed retrospectively. RESULTS The subjects included 21 men and three women, with a mean age of 50.58 years. The chief complaint was abdominal pain in all patients. The mean follow-up was 10.08 months. Among the 24 patients examined, two patients (8.33%) showed no obvious changes in the CT. Twenty patients were treated by conservative strategy. One case underwent exploratory laparotomy along with embolectomy and arteriotomy. Another three cases received angioplasty and stent implanting. Complete and partial remodeling was observed in 15 (62.5%) and four patients (16.67%). Three (12.5%) of the lesions had dissection remodeling and aneurysm change. CONCLUSIONS SIHSMA represented variable vascular remodeling, while most of the patient got a complete resolution during follow-up, and its clinical course was benign in this study. Vast majority of patients can be managed conservatively when there are no signs indicating organ ischemia.

    更新日期:2019-11-01
  • Long-Term Single-Center Retrospective Follow-Up After Embolization of Pulmonary Arteriovenous Malformations Treated Over a 20-year Period: Frequency of Re-canalization with Various Embolization Materials and Clinical Outcome.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-03-20
    Poul Erik Andersen,Stevo Duvnjak,Oke Gerke,Anette Drøhse Kjeldsen

    PURPOSE The present study is a register-based observational study of an unselected consecutive patient cohort with pulmonary arteriovenous malformations (PAVMs) from a single national hereditary hemorrhagic telangiectasia and PAVM embolization center. The aim was to investigate the frequency of re-embolizations and the clinical outcome after embolization with the use of different embolization materials further, to define which PAVM morphology and size of feeding arteries that most often were re-embolized, and to estimate the clinical outcome of the patients including those that were re-embolized. METHODS The population was included from 1996 until 2016 and was made up of a total of 136 patients with 322 PAVMs. Median follow-up was 38.3 (0.3-241 months). RESULTS The re-embolization rate was 9.3%. None of the PAVMs treated with detachable silicone balloons were re-embolized, while 4.5% treated with vascular plugs and 11.7% treated with coils were re-embolized (p=0.07). In total, 16/74 complex PAVMs were re-embolized compared with 14/248 simple PAVMs. In big-sized feeding arteries ≥ 6mm, 16/112 were re-embolized compared with 14/210 with smaller-sized feeding arteries. Out of the 30 re-embolized PAVMs, 23 resulted in a successful clinical outcome. CONCLUSIONS Our results suggest that standard coils probably should not be the first choice for embolization of PAVMs, and vascular plug alone or in combination with coils might be a better primary option for embolization in these patients. LEVEL OF EVIDENCE Level 3A, non-randomized case controlled cohort/follow-up study.

    更新日期:2019-11-01
  • Post-Biopsy Manoeuvres to Reduce Pneumothorax Incidence in CT-Guided Transthoracic Lung Biopsies: A Systematic Review and Meta-analysis.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-03-14
    Ya Ruth Huo,Michael Vinchill Chan,Al-Rahim Habib,Isaac Lui,Lloyd Ridley

    This systematic review and meta-analysis investigated post-biopsy manoeuvres to reduce pneumothorax following computed tomography-guided percutaneous transthoracic lung biopsy. Twenty-one articles were included with 7080 patients. Chest drain insertion rates were significantly reduced by ninefold with the normal saline tract sealant compared to controls (OR 0.11, 95% CI 0.02-0.48), threefold with the rapid rollover manoeuvre to puncture site down (OR 0.34, 95% CI 0.18-0.63), threefold with the tract plug (OR 0.33, 95% CI 0.22-0.48) and threefold with the blood patch (OR 0.39, 95% CI 0.26-0.58). The absolute chest drain insertion rates were the lowest in the normal saline tract sealant (0.8% vs 7.3% for controls), rapid rollover (1.9% vs 5.2%), deep expiration and breath-hold on needle extraction (0.9% vs 1.8%) and standard rollover versus no rollover (2.6% vs 5.2%). These findings highlight post-biopsy manoeuvres which could help reduce pneumothorax and chest drain insertions following lung biopsies. LEVEL OF EVIDENCE: Level 1/no level of evidence, systematic review.

    更新日期:2019-11-01
  • Biliary Leakage After Hepatobiliary and Pancreatic Surgery: A Classification System to Guide the Proper Percutaneous Treatment.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Giancarlo Mansueto,Francesco Lorenzo Gatti,Enrico Boninsegna,Simone Conci,Alfredo Guglielmi,Alberto Contro

    PURPOSE To investigate the effectiveness of percutaneous approaches to treat bile leak and to propose an anatomical classification of biliary fistula to guide the most appropriate percutaneous approach. MATERIALS AND METHODS Fifty-six patients with bile leakage after hepatobiliary surgery were included. Based on preoperative images and postoperative fistulogram images, three categories of bile leakage were defined. Every category was treated with non-surgical approaches (internal-external percutaneous drainage, percutaneous/endoscopic biliodigestive anastomosis with rendez-vous technique and biliodigestive percutaneous anastomosis with totally radiologic rendez-vous). RESULTS In 44/56 (78%) patients, anatomical conformation was "direct communication" (bile ducts upstream from the leak present a direct communication with downstream ducts) and their treatment was conventional percutaneous drainage. In 5/56 (9%), anatomical conformation was "indirect communication" (bile ducts upstream from the leak communicate with downstream ducts through a bile collection) and treatment was percutaneous/endoscopic rendez-vous technique. In 7/56 (12%), anatomical conformation was "no communication" (ducts upstream from the leak are completely excluded from ducts downstream) and treatment was totally radiologic rendez-vous. In 54/56 (96%) during the follow-up, cholangiography revealed complete resolution of the leak without residual stenosis and drains were removed. Complications occurred in 12/56 (21%). Procedure-related mortality was 0%. Ten patients, after > 6 months from resolution of their fistula and drain removal, died due to cancer recurrence. Currently, 44/56 patients (77%) at long-term follow-up (> 12 months) are alive, without bile leak. CONCLUSION Our classification helps to choose the most proper percutaneous approach in all kinds of bile leakage, even in severe cases; these are safe techniques with a high success rate.

    更新日期:2019-11-01
  • Correction to: Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2018-12-13
    Tim A Labeur,R Bart Takkenberg,Heinz-Josef Klümpen,Otto M van Delden

    Toward the end of the second paragraph in the Discussion section, there is a word missing in the sentence.

    更新日期:2019-11-01
  • PET/CT Imaging Characteristics After Radioembolization of Hepatic Metastasis from Breast Cancer.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Amy R Deipolyi,Ryan W England,Fourat Ridouani,Christopher C Riedl,Henry S Kunin,F Edward Boas,Hooman Yarmohammadi,Constantinos T Sofocleous

    PURPOSE To define positron emission tomography/computed tomography (PET/CT) imaging characteristics during follow-up of patients with metastatic breast cancer (MBC) treated with yttrium-90 (Y90) radioembolization (RE). MATERIALS AND METHODS From January 2011 to October 2017, 30 MBC patients underwent 38 Y90 glass or resin RE treatments. Pre-RE PET/CT was performed on average 51 days before RE. There were 68 PET/CTs performed after treatment. Response was assessed using modified PERCIST criteria focusing on the hepatic territory treated with RE, normalizing SUVpeak to the mean SUV of liver uninvolved by tumor. An objective response (OR) was defined as a decrease in SUVpeak by at least 30%. RESULTS Of the 68 post-RE scans, 6 were performed at 0-30 days, 15 at 31-60 days, 9 at 61-90 days, 13 at 91-120 days, 14 scans at 121-180 days, and 11 scans at > 180 days after RE. Of the 30 patients, 25 (83%) achieved OR on at least one follow-up. Median survival was 15 months after the first RE administration. Highest response rates occurred at 30-90 days, with over 75% of cases demonstrating OR at that time. After 180 days, OR was seen in only 25%. There was a median TTP of 169 days among responders. CONCLUSION In MBC, follow-up PET/CT after RE demonstrates optimal response rates at 30-90 days, with progression noted after 180 days. These results help to guide the timing of imaging and also to inform patients of expected outcomes after RE.

    更新日期:2019-11-01
  • Is This the End for EVAR?
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Raman Uberoi,Michael Jenkins

    更新日期:2019-11-01
  • Preliminary Experience of Viabahn Stent Graft Inside the Occluded Prosthetic Bypass Graft for the Treatment of Above Knee Femoropopliteal Bypass Occlusion.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Naoki Fujimura,Hideaki Obara,Kazuomi Iwasa,Tsutomu Hattori,Hiroshi Yamamoto,Susumu Watada,Taira Kobayashi,Nobuhiro Suematsu,Hiroshi Mitsuoka,Yoshimitsu Soga,Tatsuya Nakama,Ryohei Sakamoto,Shigeo Ichihashi

    PURPOSE To describe a multi-center preliminary experience of treating prosthetic above knee femoropopliteal (AKFP) bypass occlusion by placing a Viabahn stent graft inside the occluded prosthetic bypass graft. MATERIALS AND METHODS Retrospective analysis of consecutive 14 patients (mean age 73.2 ± 10.2, 78.6% male) receiving Viabahn stent graft inside the occluded prosthetic bypass graft for the treatment of prosthetic AKFP bypass occlusion in the collaborating hospitals from November 2016 to June 2019 was performed. RESULTS Technical success was achieved in all patients. Mean lesion length was 34.0 ± 3.5 cm, concomitant thrombectomy or thrombus aspiration was performed in 11 patients (78.6%), and average of 1.57 ± 0.65 Viabahn stent grafts were used. Mean ankle-brachial index improved from 0.24 ± 0.23 to 0.98 ± 0.14 after the treatment. All patients had preoperative ischemic symptoms with 9 patients (64.3%) having Rutherford class > 4 symptoms; however, all preoperative symptoms resolved after the treatment. During the mean follow-up of 450.9 ± 234.7 days, there were two target lesion revascularizations, leading to a primary patency rate of 92.9% and a secondary patency of 100.0% at 1 year. CONCLUSION Placing a Viabahn stent graft inside the occluded prosthetic bypass graft for the treatment of prosthetic AKFP bypass occlusion appears to be effective from our preliminary experience. Even though sample size is limited in our study, it may be considered as a potential treatment option before surgical reintervention.

    更新日期:2019-11-01
  • Chemoembolization with Degradable Starch Microspheres for Treatment of Patients with Primary or Recurrent Unresectable, Locally Advanced Intrahepatic Cholangiocarcinoma: A Pilot Study.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-10-04
    Fabian Goerg,Markus Zimmermann,Philipp Bruners,Ulf Neumann,Tom Luedde,Christiane Kuhl

    PURPOSE To evaluate efficacy and complication rates of TACE with degradable starch microspheres (DSM-TACE) in patients with unresectable intrahepatic cholangiocarcinoma (ICC) with or without prior major liver resection (MLR). METHODS This is a retrospective single-center study on 21 patients (age 63 ± 15 years) with either unresectable ICC progressive under systemic chemotherapy or unresectable intrahepatic tumor recurrence after prior MLR. Patients were treated by multi-agent (cisplatin/doxorubicin/mitomycin C) DSM-TACE between August 2012 and July 2016, repeated 3 times at 4-week intervals. Imaging response was evaluated using RECIST 1.1. Overall survival (OS) and complication rates, stratified by history of MLR, were investigated. RESULTS Patients underwent a total 64 DSM-TACE sessions. Two patients (without MLR) were lost to follow-up after one uneventful DSM-TACE session. One patient underwent living-donor-liver transplantation after one DSM-TACE-session yielding partial remission. Of the remaining 18 patients, imaging response according to RECIST 1.1 was: complete remission in 2/18 (11.1%); PR in 9/18 (50%), and stable disease in 7/18 (38.9%), yielding an objective response rate of 61.1% and a disease control rate of 100%. Median OS of patients with objective response was significantly longer (18.0 months) than that of survival of patients with stable disease (4.8 months) (p = 0.001). Median OS of patients with MLR (12.5 months) was similar to that of patients without MLR (13.2 months). Of 21 patients, 2 (9.5%) developed post-interventional hepatobiliary abscesses, and one of these patients died due to subsequent sepsis. CONCLUSION DSM-TACE is an effective treatment for unresectable and otherwise therapy-refractory intrahepatic cholangiocarcinoma, even in those patients with intrahepatic disease recurrence after prior MLR. LEVEL OF EVIDENCE Level II, therapeutic study.

    更新日期:2019-11-01
  • Efficacy of Paclitaxel Balloon for Hemodialysis Stenosis Fistulae After One Year Compared to High-Pressure Balloons: A Controlled, Multicenter, Randomized Trial.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-11-14
    T Moreno-Sánchez,M Moreno-Ramírez,F H Machancoses,P Pardo-Moreno,P F Navarro-Vergara,J García-Revillo

    PURPOSE A controlled, prospective, multicenter, randomized trial to compare primary patency after angioplasty with a drug-coated balloon versus plain angioplasty balloon in stenosis of dysfunctional fistulae and grafts for hemodialysis. MATERIALS AND METHODS A total of 136 patients (148 angioplasties) at four centers were randomized to receive a drug-coated balloon or plain angioplasty balloon after satisfactory angioplasty with a high-pressure balloon. The inclusion criteria were clinical signs of vascular dysfunction confirmed by Doppler Ultrasound and/or angiography. The primary endpoint was target lesion patency defined as time elapsed between the completion of effective and the appearance of restenosis at 6 and 12 months after angioplasty. Secondary endpoints included the relationship between the location of the stenosis, previous angioplasty, demographic variables and survival. RESULTS Primary patency after angioplasty was higher in the group treated with the drug-coated balloon than the plain angioplasty balloon (153.01 to 141.69 days at 6 months; 265.78 to 237.83 days at 12 months). Drug-coated balloon angioplasty resulted in superior patency after 6 and 12 months, but this result was not statically significant (P = 0.068 at 6 months; P = 0.369 at 12 months). There was no relation between target lesion patency and the other variables studied. Overall mortality in the plain angioplasty balloon group was higher (9% vs. 5.7%) but not statistically significant. CONCLUSIONS Drug-coated balloon angioplasty resulted in superior survival of dysfunctional peripheral vascular access at 6 and 12 months, but this result was not statistically significant. Both arms show equivalent complications and similar mortality. LEVEL OF EVIDENCE Level Ia, therapeutic study, RCT. EBM ratings will be based on a scale of 1-5.

    更新日期:2019-11-01
  • 90Y Resin Microspheres Radioembolization for Colon Cancer Liver Metastases Using Full-Strength Contrast Material.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2018-05-17
    I Kurilova,R G H Beets-Tan,G A Ulaner,F E Boas,E N Petre,H Yarmohammadi,E Ziv,A R Deipolyi,L A Brody,M Gonen,Constantinos T Sofocleous

    OBJECTIVES To assess safety and efficacy of 90Y resin microspheres administration using undiluted non-ionic contrast material (UDCM) {100% Omnipaque-300 (Iohexol)} in both the "B" and "D" lines. MATERIALS AND METHODS We reviewed all colorectal cancer liver metastases patients treated with 90Y resin microspheres radioembolization (RAE) from 2009 to 2017. As of April 2013, two experienced operators started using UDCM (study group) instead of standard sandwich infusion (control group). Occurrence of myelosuppression (leukopenia, neutropenia, erythrocytopenia or/and thrombocytopenia), stasis, nontarget delivery (NTD), median fluoroscopy radiation dose (FRD), median infusion time (IT), liver progression-free (LPFS) and overall survivals (OS) was evaluated. Complications within 6 months post-RAE were reported according to CTCAE v3.0 criteria. RESULTS Study and control groups comprised 23(28%) and 58(72%) patients, respectively. Median follow-up was 9.1 months. There was no statistically significant difference in myelosuppression incidence within 6 months post-RAE between groups. Median FRD and IT for study and control groups were 44.6 vs. 97.35 Gy/cm2 (p = 0.048) and 31 vs. 39 min (p = 0.006), respectively. A 38% lower stasis incidence in study group was not significant (p = 0.34). NTD occurred in 1/27(4%) study vs. 5/73(7%) control group procedures (p = 1). Grade 1-2 and grade 3-4 toxicities between study and control group patients were 36%(8/22) vs. 45%(26/58), p = 0.61 and 9%(2/22) vs. 16%(9/58), p = 0.72, respectively. There was no difference in LPFS and OS between groups. CONCLUSION Administration of 90Y resin microspheres using UDCM in both lines is safe and effective, resulting in lower fluoroscopy radiation dose and shorter infusion time, without evidence of myelosuppression or increased stasis incidence.

    更新日期:2019-11-01
  • Stratification of Pre-procedure Risk Factors Associated with Difficult-to-remove Inferior Vena Cava (IVC) Filters: A 6-year Retrospective Analysis at a Tertiary Center.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Warren Clements,Heather K Moriarty,Eldho Paul,Gerard S Goh

    PURPOSE Currently, data surrounding predicting difficulty of IVC filter retrievals are heterogenous and conflicting. We aimed to identify which of many variables associated with IVC filters is a risk for procedural difficulty. MATERIALS AND METHODS This study retrospectively reviewed 6 years of IVC filter retrievals at a tertiary center identifying 356 consecutive retrievals. A difficult retrieval was defined as any case where the fluoroscopy time exceeded 7 min, an advanced technique was required, the retrieval attempt failed and required an additional attempt or was left permanent, or there was major complication such as IVC filter fracture/migration/vessel injury. RESULTS There were 105 filter retrievals defined as difficult (29.5%). Univariate analysis showed significantly increased risk for retrievals with an embedded top. Multivariate analysis assessed the association between dwell time, tilt, age, non-hooked filters, leg penetration and difficult retrieval. This showed a significant increase in the difficulty of retrieval for filters tilted between 5° and 15° (odds ratio 2.38, p < 0.001), for filters tilted more than 15° (odds ratio 7.91, p < 0.001), and dwell time greater than 6 months (odds ratio 2.06, p = 0.033). No significant increase in difficulty was seen with filters with a dwell time of less than 6 months, leg penetration, non-hooked filters, or with increasing patient age. CONCLUSIONS Identifying these risks in patients in advance of the procedure allows appropriate planning and improved workflow efficiency.

    更新日期:2019-11-01
  • Improved Local Tumor Control and Survival Rates by Obtaining a 3D-Safety Margin in Superselective Transarterial Chemoembolization for Small Hepatocellular Carcinoma.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Thanate Kattipatanapong,Hideyuki Nishiofuku,Toshihiro Tanaka,Takeshi Sato,Tetsuya Masada,Shota Tatsumoto,Takeshi Matsumoto,Kimihiko Kichikawa

    OBJECTIVE To investigate technical factors affecting local tumor control of small hepatocellular carcinoma (HCC) treated by superselective conventional transarterial chemoembolization (cTACE) using lipiodol and to compare prognoses between groups with and without these factors. MATERIALS AND METHODS Sixty-three consecutive patients with 73 HCC nodules (diameter, 1-3 cm) treated by cTACE were retrospectively analyzed. A positive or a negative 3D-safety margin was defined as a ≥ 1-mm area of lipiodol accumulation or as a diameter of lipiodol accumulation < 1 mm in liver parenchyma surrounding the tumor using plain CT images obtained within a week after TACE. Uni- and multivariate analyses were performed to identify technical factors determining local tumor control rate. Subgroup analysis of survival rates in treatment-naïve patients was performed according to the detected factors. RESULTS In univariate analyses, three-dimensional (3D)-safety margin and portal vein visualization were associated with local tumor control rates. In multivariate analysis, only positive 3D-safety margin remained a significant contributor (p = 0.001). Two-year cumulative local disease-free survival rates with positive and negative 3D-safety margin were 82.8% and 19.3%, respectively (p = 0.001). In subgroup survival analysis of the 36 newly diagnosed patients, the 1-, 2-, 3-, 4-, and 5-year cumulative OS rates for patients with and without positive margins were 100% versus 100%, 96.4% versus 75.0%, 81.8% versus 62.5%, 74.4% versus 41.7%, and 47.0% versus 0%, respectively (median survival time; 57.6 months vs. 37.1, p = 0.047). CONCLUSION Obtaining a 3D-safety margin can suppress local tumor recurrence and prolong survival in superselective cTACE for small HCC.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Catheter-Directed Computed Tomography Hepatic Angiography for Yttrium-90 Selective Internal Radiotherapy of Hepatocellular Carcinoma Reduces Prophylactic Embolization of Extrahepatic Vessels.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Winfred Xi Tai Goh,Sum Leong,Chow Wei Too,Lionel Tim-Ee Cheng,Seyed Ehsan Saffari,Rebekah Zhuyi Lee,Sean Tze Shen Ng,Richard Hoau Gong Lo,Kiang Hiong Tay,Shaun Xavier Ju Min Chan,Apoorva Gogna,Farah Gillan Irani,Nanda Venkatanarasimha,Kelvin Siu Hoong Loke,Pierce Kah Hoe Chow,David Chee Eng Ng,Thijs August Johan Urlings,Ankur Patel,Karthikeyan Damodharan,Luke Han Wei Toh,Bien Soo Tan

    OBJECTIVES To determine the rate of prophylactic embolization of extrahepatic vessels in patients undergoing yttrium-90 selective internal radiotherapy (90Y SIRT) for hepatocellular carcinoma (HCC) with the use of catheter-directed computed tomography hepatic angiography (CD-CTHA). MATERIALS AND METHODS This retrospective study included 186 HCC patients who received 90Y SIRT from May 2010 to June 2015 in a single institution. All procedures were performed in a hybrid angiography-CT suite equipped with digital subtraction angiography (DSA) and CD-CTHA capabilities. CD-CTHA was performed during pre-treatment hepatic angiography. 90Y SIRT was administered approximately 2 weeks later. Selective prophylactic embolization of extrahepatic vessels was performed if extrahepatic enhancement was seen on CD-CTHA or if an extrahepatic vessel opacified on DSA/CD-CTHA despite the final microcatheter position for 90Y microsphere delivery being beyond the origin of this vessel. RESULTS Thirty-five patients (18.8%) required selective embolization of extrahepatic vessels. Technical success of 90Y SIRT was 99.5%. Two patients (1.1%) developed radiation-induced gastrointestinal ulceration, and one (0.54%) developed radiation-induced pneumonitis. Extrahepatic uptake of 90Y microspheres was seen in the gallbladder of one patient without significant complications. CONCLUSION The use of CD-CTHA in 90Y SIRT of HCC was associated with a low rate of prophylactic embolization of extrahepatic vessels while maintaining a high technical success rate of treatment and low rate of complications. LEVEL OF EVIDENCE Level 4, case series.

    更新日期:2019-11-01
  • Transarterial Chemoembolisation (TACE) with Degradable Starch Microspheres (DSM) and Anthracycline in Patients with Locally Extensive Hepatocellular Carcinoma (HCC): Safety and Efficacy.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Alexander Gross,Thomas Albrecht

    PURPOSE To evalutate safety and efficacy of degradable starch microspheres (DSM) as embolic agent in transarterial chemoembolisation (TACE) of unresectable, locally extensive hepatocellular carcinoma (HCC). MATERIALS AND METHODS In this retrospective study, 37 patients with intermediate to advanced HCC treated with ≥ 3 chemoembolisations with doxorubicin/epirubicin and DSM were analysed. Patients were treated with three consecutive chemoembolisations in 4-weekly intervals. Clinical parameters and laboratory findings were obtained from patient records before and after each intervention. Tumour response was assessed after every 3 embolisations by CT/MRI according to modified response evaluation criteria in solid tumours. RESULTS Thirty-seven patients with HCC were treated with 177 DSM-TACEs (3-12/patient, mean 4.8). Disease stages according to the Barcelona Clinic Liver Cancer (BCLC) staging system were: 27 × B, 9 × C, 1 × D. Five patients had uninodular, 32 multinodular (23 bilobar) disease. Three patients had portal vein invasion. Apart from one possibly procedure-related grade 3 complication, only grade 1 adverse events occurred. These were pain reacting to analgesics (23%), transient nausea (11%), vomiting (3%) and post-embolisation syndrome (4%). Transient laboratory changes were bone marrow toxicity (29%) and increase in INR (14%), creatinine (8%) or bilirubin (38%). Tumour response was objective response rate 49%, disease control rate 83%. Median survival was 19 months: 22 months for BCLC stage B and 6.7 months for BCLC stages C + D. Responders had a significantly better prognosis than non-responders. CONCLUSION DSM-TACE of HCC is safe even in patients with advanced disease stages. Tumour response and survival rates were encouraging in our series of patients with locally extensive disease.

    更新日期:2019-11-01
  • Correction To: Where is the Origin of the Last Normal Branch from Feeding Artery of Pulmonary Arteriovenous Malformations?
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-07-20
    Miyuki Maruno,Hiro Kiyosue,Norio Hongo,Shunro Matsumoto,Hiromu Mori

    On page 1852, the first sentence of the second paragraph "In all PAVMs, the mean diameter of the feeding artery was 7.24 ± 0.015 mm, and the mean maximum diameter of the sac was 19.10 ± 0.585 mm" should be corrected to read as follows.

    更新日期:2019-11-01
  • Telemedicine: Can In-Person Pre-treatment Communication be Expanded by Video Consultation?
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-09-08
    S Guhl,L Linngrön,B Rosenberg,N Hosten,M Kirsch

    更新日期:2019-11-01
  • Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Schistosomiasis-Induced Liver Fibrosis.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-08-01
    Jiacheng Liu,Binqian Zhou,Dongpin Chen,Chen Zhou,Qin Shi,Chuansheng Zheng,Gansheng Feng,Feng Yuan,Yan Ge,Bin Xiong

    PURPOSE Evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) insertion on patients with schistosomiasis-induced liver fibrosis, and compare with that of patients with HBV-induced cirrhosis. MATERIALS AND METHODS This was a retrospective study from November 2015 to December 2018 including 82 patients diagnosed with portal hypertension, one group of which is induced by schistosomiasis (n = 20), the other by hepatitis B virus (HBV) (n = 62). Both groups of subjects underwent TIPS placement for the management of portal hypertension complications. RESULTS TIPS was inserted successfully in all patients (technical success 100%). After a median follow-up of 14 months following TIPS insertion, portal pressure gradient (PPG) value in both schistosomiasis-induced group and HBV-induced group underwent a significant decrease with no major difference between the two groups. There exists no significant difference demonstrated by Kaplan-Meier curves between two groups concerning cumulative rate of hepatic encephalopathy (HE) (log-rank p = 0.681), variceal rebleeding (log-rank p = 0.837) and survival (log-rank p = 0.429), and no statistically difference was found in terms of alleviation of portal vein thrombosis (PVT). In addition, splenectomy (HR 19, 95% CI 4-90, p < 0.001) was identified as independent predictor of PVT. CONCLUSIONS TIPS placement is well-founded to be considered as a safe and effective treatment in patients with schistosomiasis-induced portal hypertension and relevant severe complications. We also found the risk of PVT is 19 times higher in patients who underwent splenectomy than in untreated patients. LEVEL OF EVIDENCE Historically controlled studies, level 4.

    更新日期:2019-11-01
  • A Technical Report on the Performance of a New Large Bore Cerebral Aspiration Catheter, the First Results.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : 2019-07-04
    Faysal Benali,Robert-Jan B Goldhoorn,Bart A J M Wagemans,Christiaan van der Leij,Rutger J B Brans,Sanne W de Boer,Michiel W de Haan,Wim H van Zwam

    AIMS AND BACKGROUND We describe the initial results of the Syphontrack Super Distal Access (SDA) catheter (InNeuroco Inc., Sunrise, Fl, USA) used for endovascular treatment of patients with acute ischemic stroke of the anterior circulation. METHODS A retrospective review of prospectively collected data from June 2017 to May 2018 in Maastricht University Medical Center plus (MUMC +) with direct distal aspiration or a combination of distal aspiration with stent retriever thrombectomy was performed. Primary outcome measurements were accessibility and reperfusion grade (eTICI). Secondary outcome measurements were early neurologic recovery (a decrease of four or more points on the NIHSS), symptomatic intracranial hemorrhage (sICH) within 24 h and mRS score at 3 months. RESULTS The first 50 patients in whom the SDA catheter was used are included. Direct distal aspiration was performed in 33/50 (66%). In 29/33 (88%), distal position in contact with the clot was achieved of which 15 (52%) were successful (eTICI 2b or higher) after first attempt. Total successful reperfusion rate was 23/50 (46%) after first pass. Final successful reperfusion, after multiple attempts, was reached in 48/50 (96%). Early neurologic recovery was seen in 21/50 (42%), and functional independence (mRS score of 0-2) at 3 months was achieved in 17/50 (35%). sICH occurred in 4/50 (8%) within 24 h post-procedural. CONCLUSION In our clinical practice, endovascular treatment of ischemic stroke with the SDA catheter had similar technical and clinical results as reported in the literature.

    更新日期:2019-11-01
  • Endovascular Management of Hemarthrosis in Patients with Bleeding Diatheses: Systematic Review.
    Cardiovasc. Interv. Radiol. (IF 1.928) Pub Date : null
    Srinidhi Shanmugasundaram,Vishnu Chandra,Marcin Kolber,Abhishek Kumar,Sohail Contractor,Pratik A Shukla

    PURPOSE In this systematic review, we report the safety and efficacy of embolization for treating hemarthrosis in patients with bleeding diatheses with or without a history of prior arthroplasty. MATERIALS AND METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, MEDLINE, and SCOPUS databases of patients undergoing embolization for hemarthrosis. Demographic data, clinical history, angiographic findings, interventions, and outcomes were extracted and tabulated. RESULTS The search identified 97 unique titles of which 15 were deemed relevant comprising 78 patients with coagulopathies undergoing 93 embolization procedures. Mean follow-up time was 29 months (range 3-116.5). In the 29 patients who underwent arthroplasty prior to embolization for hemarthrosis, there were 11 bleeding recurrences (37.9%). Of these patients who experienced recurrences, 10 underwent repeat embolization as coagulation factor replacement was not sufficient to address the re-bleeding. In the 49 patients with bleeding diatheses who underwent embolization for hemarthrosis with no history of prior arthroplasty, there were 11 recurrences (22.4%) and 4 of these patients underwent repeat embolization with favorable results. There were four major procedure-related complications. CONCLUSION Transarterial embolization is safe and effective in addressing recurrent hemarthrosis in patients with bleeding diatheses with or without a history of arthroplasty of the affected joint.

    更新日期:2019-11-01
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