Cirse Quality Assurance Document and Standards for Classification of Complications: The Cirse Classification System

Enhancing Outcomes in Transarterial Embolization for Late Postpancreatectomy Hemorrhage: A Comparison of N-Butyl Cyanoacrylate with Mixed Embolic Agents Versus Mixed Embolic Agents Alone

BACKGROUND

This study aimed to retrospectively compare the efficacy of transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) and conventional agents (microcoils, polyvinyl alcohol [PVA], or gelatin sponge) in the treatment of patients with late postpancreatectomy hemorrhage (late-PPH).

METHODS

From June 2012 to June 2022, this retrospective study enrolled 130 consecutive patients who underwent TAE treatment due to late-PPH at one institution. Of these patients, 56 were treated with NBCA-mixed conventional agents (NBCA-MA group), and 74 were treated with mixed conventional agents alone (MA group). The patients' clinical characteristics and TAE details were gathered. The clinical outcomes in the two groups were compared. Using univariate and multivariate logistic regression analyses, prognostic factors were evaluated for clinical success and 30-day mortality rates.

RESULTS

The clinical success in the NBCA-MA group was 80.4% higher than that in the MA group (60.8%). Rebleeding was significantly more common in the MA group (29.7% vs. 8.9%). The 30-day mortality rate of the NBCA-MA group was lower than that of the MA group (16.1% vs. 33.8%). NBCA use was a significant prognostic factor associated with clinical success, while age and NBCA use were significant factors associated with the 30-day mortality rate.

CONCLUSION

In conclusion, we found that TAE with NBCA is a safe and effective method for treating late-PPH.

Minimally Invasive Treatment of Aneurysmal Bone Cysts with Gelified Ethanol (DiscoGel®): Evaluation of Feasibility, Safety, and Efficacy

INTRODUCTION

Aneurysmal bone cysts are locally aggressive bone lesions. The aim of this study was to evaluate safety and effectiveness of radio-opaque gelified ethanol sclerotherapy in treating primary aneurysmal bone cyst.

MATERIALS AND METHODS

In this single-center, retrospective study (January 1st, 2012, to June 30th, 2024), 32 patients with primary aneurysmal bone cysts were treated with percutaneous sclerotherapy using radio-opaque gelified ethanol at various skeletal sites. Of these, 27 patients were included in the analysis, 5 patients were excluded due to follow-up of less than 12 months. The primary outcome measure was the safety of the procedures. Secondary outcomes measures included clinical success, defined as the absence of post-sclerotherapy fractures or the need for surgical revision, and radiological success, determined by the conversion of an active or aggressive aneurysmal bone cyst to inactive, according to Campanacci's classification.

RESULTS

No major complications related to the procedure were observed. One minor complication (3.7%) was reported: One local collection resolved with antibiotic therapy. The remaining patients showed favorable clinical and radiological outcomes. No fractures were recorded after sclerotherapy. Surgical revision for progressive recurrence was necessary in 2 cases (7.4%). Aneurysmal bone cyst becoming inactive in 21 of 27 (77.8%) patients after 12 months, 13 of 14 (92.8%) patients after 24 months, and 7 of 7 (100%) and 5 of 5 (100%) patients after more than 36 and 48 months, respectively.

CONCLUSION

Radio-opaque gelified ethanol sclerotherapy offers a safe, effective, and minimally invasive treatment for primary aneurysmal bone cyst. It may be considered a first-line approach, similar to other sclerotherapy methods, potentially avoiding the need for invasive surgery as an initial treatment option.

Outcomes and Complications of Image-Guided Percutaneous Tumour Ablation for Hepatocellular Carcinoma at the Irish National Liver Transplant Centre

Background: Image-guided tumour ablation is a minimally invasive treatment for early stage hepatocellular carcinoma (HCC). Our study reviews the complications and long term outcomes in patients treated at a tertiary referral centre. Methods: Retrospective study. All patients with HCC who underwent microwave ablation (MWA) or radiofrequency ablation (RFA) from 1st January 2014 to 31st December 2022 were identified. Treatment response of target lesion, complications, and survival were recorded. Results: One hundred seventy ablations were performed in 118 patients; 70% MWA, 30% RFA. Median radiological follow-up 21 months (range 3-107). Follow-up imaging was reported using LI-RADS and mRECIST. At first follow-up imaging, 94 patients had complete response (primary efficacy rate 80.3%) while 19.7% (n = 23) had residual disease. Fifteen of these had repeat ablation; 10 had complete response (secondary efficacy rate 85.6%). By end of study duration, 70.5% (n = 79) achieved sustained local complete response from single ablation without documented recurrence. 14.3% (n = 16) required more than one ablation of target lesion. Overall, 84.8% (n = 95) demonstrated long term local complete response to ablation. Complication occurred in 5.9% (n = 10); 40.0% Grade I, 40.0% Grade II, 10.0% Grade III, 10.0% Grade IV as per the CIRSE Classification. 1-, 3-, and 5-year overall survival (OS) rate was 97%, 68%, and 61% respectively. Mean OS was 5.3 years (median 4.7). No difference in OS (P = .7) or local progression free survival (P = .5) between patients treated with MWA versus RFA. Conclusion: This study demonstrates excellent long-term response to TA, with acceptable complication profile. No difference in survival between RFA versus MWA.

Study Protocol DEDICATE: Italian Multicenter Study on the Treatment of Visceral Aneurysms with the Derivo Peripher and Derivo 2 Flow Diverter Stent

PURPOSE

This study aims to evaluate the safety and efficacy of the Derivo peripher and Derivo 2 Embolization Device Flow Diverter Stents (DEDs, Acandis GmbH) in treating visceral aneurysms.

MATERIALS AND METHODS

This multicentric registry with core-lab evaluation involves 29 Italian Interventional Radiology and Vascular Surgery units, targeting 100 patients. Inclusion criteria include visceral artery aneurysms without signs of rupture and adherence to correct DED stent sizing and anticoagulant and antiplatelet protocols. Patients will undergo physical examination and computed tomography angiography (CTA) within 6-month and at 1-year post-procedure. A core laboratory will evaluate all pre- and post-procedure CTA and procedural angiographic images for procedural correctness (adherence to correct DED sizing, deployment accuracy, and technical issues), stent morphology during follow-up (patency and geometrical changes), and VAA morphological changes (volume variation, thrombosis grade, and number of patent branches). The primary objective is to evaluate the technical efficacy and safety of DEDs at 1-year follow-up. Efficacy will be assessed by patency of DEDs and side branches, aneurysm thrombosis (< 50%, > 50% or total volume of the aneurysm), and non-increase in aneurysm volume (percentage change relative to initial volume). Safety will be assessed by morbidity (adverse events during follow-up), mortality (any cause of death), and technical issues (adverse events during stent placement, based on CIRSE classification of complications).

EXPECTED GAIN OF KNOWLEDGE

The DEDICATE registry will provide further information on the effectiveness of flow-diverting stents in treating visceral aneurysmal pathology. Trial Registration ClinicalTrials.gov identifier: NCT06325371.

Cone beam CT pulmonary angiography in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension during the program initiation period

AIM

Cone beam CT pulmonary angiography (CBCT-PA) has proven to be a valuable technique during balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH) in established centres. This study aimed to demonstrate the safety and efficacy of CBCT-PA-guided BPA for CTEPH during the initial period of a BPA program. CBCT-PA improves procedural accuracy by visualising distal thromboembolic lesions and providing real-time guidance, which is critical during program initiation.

MATERIALS AND METHODS

This single-centre, single-arm study prospectively evaluated patients with CTEPH undergoing BPA from 2017 to 2022. Outcomes of interest included pre-BPA and post-BPA 6-minute walking distance, New York Heart Association Functional Classification (NYHA-FC), mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), N-terminal pro B-type natriuretic peptide (NT-proBNP), and BPA-related adverse events (AEs). Statistical analysis compared pre-BPA and post-BPA results. CBCT-PA was used for three-dimensional (3D) vascular mapping and precise lesion targeting.

RESULTS

Ninety BPA sessions were performed on 19 patients under CBCT-PA guidance. Significant improvements were observed in mPAP (37.0 mmHg [interquartile range (IQR): 28.0-46.0] vs 25.5 [IQR: 22.8-31.5]; P<0.001), PVR (5.5 Wood units [IQR: 3.4-8.5] vs 3.3 [IQR: 2.7-4.6]; P < 0.001), NYHA-FC I-II rate (8 [42%] vs 18 [94%]; P = 0.04), and NT-proBNP (165 pg/mL [IQR: 82-1146] vs 127.0 [IQR: 57-216]; P = 0.014). Overall AE rate was 14.4%, and major AE rate was 7.7% (all Cardiovascular and Interventional Radiology Society of Europe [CIRSE] grade 3). The haemoptysis rate was 4.4%. No periprocedural deaths were reported.

CONCLUSION

BPA performed under CBCT-PA guidance appeared to be an effective and safe approach in the program's initial period, helping achieving similar results as established centres.

Percutaneous Cryoablation of Non-small Cell Lung Cancer in Patients with Recurrence After Stereotactic Body Radiation Therapy

PURPOSE

Evaluate safety and efficacy of lung cancer cryoablation in patients with stereotactic body radiation therapy (SBRT) recurrence.

MATERIALS AND METHODS

Between 9/2018 and 11/2023, all patients with non-small cell lung cancer (NSCLC) treated with lung cryoablation after SBRT recurrence were retrospectively identified. Histories of smoking, COPD, post-procedural pneumothorax, adverse events requiring immediate post-procedural hospitalization, and initiation/worsening of home oxygen requirements 3-6 months later were obtained. Technical success was defined as ability to envelope the targeted tumor with an ice-ball without premature cessation of the cryoablation protocol. Outcome measures included local control, local progression-free survival, and overall survival at 6 months, 1 year, 2 years, and 3 years.

RESULTS

29 patients with NSCLC recurrence after SBRT underwent percutaneous cryoablation with 35 treatment sessions. Mean lesion size and standard deviation was 2.8 ± 1.5 cm (Range, 1.0-7.4 cm). Pneumothorax and hospitalization rates were 44.4% (16/36) and 36.1% (14/36). The mean number of ablation probes was 2.5 ± 1.5 (Range, 1-6). Twenty-six patients had COPD (92.9%), of which 3.8% (1/26) had new or worsened home oxygen requirements. All (36/36) cryoablations achieved technical success. Local control, local progression-free survival, and overall survival were 100%/92.9%/92.9% at 6 months, 76.2%/70.8%/92.9% at 1 year, 64.9%/60.3%/62.3% at 2 years, and 31.5%/22.6%/35.4% at 3 years.

CONCLUSION

Percutaneous cryoablation of non-small cell lung cancer may be a safe and effective treatment alternative for recurrence after SBRT without worsening pulmonary function.

What Is the Safe Observation Period Following Image-Guided Percutaneous Renal Biopsies?

PURPOSE

To investigate the timing, type, and severity of complications following percutaneous, image-guided renal biopsy and to determine if the current observation period of 4 h can be safely reduced.

METHODS

Consecutive image-guided percutaneous renal biopsies performed between 2017 and 2022 in adult patients by radiology medical staff were included. The RIS-PACS imaging systems and electronic medical records (EMR) were accessed to obtain relevant patient information and procedural reports. A retrospective analysis of the type and timing of complications was performed against patient demographics and biopsy-related variables. Probabilities were calculated for a range of observation periods to assess the proportion of complications identified by shortening the observation period from 4 h.

RESULTS

Three hundred and thirty-two percutaneous renal biopsies were included, and 44 (13%) complications were identified within the 4 h observation. Twenty-nine complications were post-operative bleeding, of which 2 developed macroscopic haematuria, 25 peri-nephric haematoma and 2 had haemodynamic instability with either haematuria or peri-nephric haematoma. 64% of all complications occurred within the first hour, and 86% occurred within 2 h. Of the six complications occurring after 2 h, two were post-operative bleeding in non-targeted renal biopsies requiring admission, and the other four did not require additional observation/procedures.

CONCLUSION

The vast majority of complications after targeted and non-targeted renal biopsies tend to occur within the first 2 h of observation. Complications that occurred after 2 h observation were often pain related, something that can be overcome with a standardised post-operative analgesic regime. It may be possible to safely reduce observation times following image-guided targeted renal biopsies.

Preoperative Embolization Followed by Tumor Resection Without Time Interval in Advanced Juvenile Nasopharyngeal Angiofibroma

PURPOSE

This study explored the feasibility and security of the clinical application of preoperative embolization and tumor resection for advanced juvenile nasopharyngeal angiofibroma (JNA) without a time interval, performed on the same date, and under the same general anesthesia (GA).

MATERIALS AND METHODS

Between December 2020 and December 2023, patients with JNA underwent embolization and resection at our hospital. All patients underwent preoperative embolization using liquid embolic material under GA with partial coil assistance; the tumor was removed immediately under the same GA. Both embolization and resection were performed on the same date in the same hybrid operating room without a time interval. Outcome measures included adverse events, blood loss, residual disease, and recurrence.

RESULTS

Complete tumor embolization and complete tumor resection (R0) were achieved in 27 patients under a single GA. 1/27 patient (3.7%) experienced adverse events related to nontarget embolization of the cerebral vessels. However, due to timely detection and treatment, no functional disability occurred after delayed tumor resection and active treatment for cerebral infarction. During a mean follow-up of 12 months, 25/27 patients (92.6%) had no residual tumor seen on imaging or endoscopic evaluation, while residual tumor was observed in 2/27 patients (7.4%). No further treatments were performed. The mean blood loss in tumor resection was 911 mL (100-3400 mL).

CONCLUSION

No interval between preoperative embolization and tumor resection is a feasible and safe treatment modality in patients with advanced JNA.

Transarterial embolization for acute lower gastrointestinal bleeding: a retrospective bicentric study

Transcatheter arterial embolization (TAE) represents an effective treatment option for acute lower gastrointestinal bleeding (LGIB). This retrospective, bicentric study evaluated the safety and efficacy of TAE in 77 patients with LGIB. The mean patient age was 68.39 ± 17.54 years, and the mean pre-procedural hemoglobin was 7.87 ± 1.89 g/dL. The most common cause of LGIB was angiodysplasia (36.2%). Pre-procedural computed tomography angiography (CTA) detected active bleeding in 83% of cases. Technical success was achieved in 98.7% of patients, and 30-day clinical success was achieved in 87%. The rebleeding rate was 13%, and the ischemic complication rate was 11.7%. There were no significant associations between clinical success and sex, age, coagulopathy, first-line management, active bleeding signs, culprit vessel, superior mesenteric artery, or time between CTA and digital subtraction angiography. TAE is a safe and effective procedure for LGIB, with high technical and acceptable clinical success rates. It should be considered a standard procedure in select patients, especially when endoscopic treatment is contraindicated or not feasible.

Percutaneous image-guided cryoablation of venous malformation and fibro-adipose vascular anomaly: prognostic factors of clinical efficacy

OBJECTIVE

To assess the prognostic factors for clinical and radiological responses to percutaneous image-guided cryoablation (CA) in treating venous malformation (VM) and fibro-adipose vascular anomaly (FAVA).

MATERIALS AND METHODS

Fifty-five patients (12 males, 43 females; median age: 30 years) with symptomatic lesions (median VAS pain score: 70; median initial volume: 12.2 mm³) underwent CA between 2012 and 2023. CA was a first-line treatment in 23 patients (42%) and second-line in 32 (58%). Lesions were Goyal grade 1 in 24 cases (43%) and located on extremities in 44 (80%). Technical efficacy was assessed using MRI and applying RECIST criteria, while clinical efficacy was based on changes in VAS pain scores. Prognostic factors for residual pain were analyzed using univariable and multivariable analyses.

RESULTS

With a median follow-up of 13 months, technical success was achieved in all cases, and 20% of patients underwent multiple sessions. Technical efficacy was observed in 69% of cases, with 33% achieving complete response and 36% partial response (mean volume reduction: 47%). Clinical efficacy was reached in 72% of cases. Univariable analysis linked residual pain to sex (female, p = 0.013), initial pain level (p = 0.014), Goyal grade (p = 0.029), and residual volume (p = 0.012). Multivariable analysis revealed that grade (p = 0.035), post-therapeutic volume (p = 0.048), and completeness of treatment (p = 0.029) were statistically significant predictors.

CONCLUSION

Cryoablation is an effective management strategy for venous malformation and FAVA, with residual volume emerging as a significant indicator of clinical success.

KEY POINTS

Question Venous malformations (VA) and fibro-adipose vascular anomalies (FAVA) often cause chronic pain, with limited effective treatment options. Identifying predictors of pain relief following cryoablation could optimize patient outcomes. Findings Cryoablation achieved 72% pain relief for VA and FAVA. High lesion grade, treatment completeness, and residual volume were significantly associated with residual pain. Clinical relevance Cryoablation provides an effective, minimally invasive treatment for VA and FAVA, achieving significant pain relief while identifying predictors to optimize patient selection and outcomes.

Bronchial Arterial Chemoembolization With Drug-eluting Beads Versus With Gelfoam Particles for Advanced Nonsmall-cell Lung Cancer

BACKGROUND

Bronchial arterial chemoembolization (BACE), as a safe and effective minimally invasive treatment method, is increasingly being accepted by more and more patients with advanced nonsmall-cell lung cancer (NSCLC). In recent years, drug-eluting beads (DEB)-BACE has also been applied in the field of lung cancer. It is still unclear which is more recommended due to the limited number of comparative studies between conventional BACE (C-BACE) and DEB-BACE.

PURPOSE

To compare the safety and efficacy of C-BACE (BACE with gelfoam particles) and DEB-BACE for advanced NSCLC.

MATERIALS AND METHODS

From January 2021 to April 2023, 48 consecutive patients (37 males and 11 females) with advanced NSCLC treated with DEB-BACE (group A) or C-BACE (group B) at our center were collected retrospectively in this study. There were 18 patients in group A and 30 patients in group B. The technical success rate, adverse events, objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were compared between the 2 groups.

RESULTS

The technical success rate in both groups was 100%. The median OS times were 19.5 months and 12.5 months in group A and group B, respectively (P=0.0062). The median PFS times were 13 months and 7 months in group A and group B, respectively (P=0.0072). The ORRs at 6 months were 72.2% and 46.7% in group A and group B, respectively (P=0.084). The DCRs at 6 months were 88.9% and 63.3% in group A and group B, respectively (P=0.043). Grade 1 adverse events like chest pain, and cough were common, while serious adverse events did not occur.

CONCLUSIONS

BACE with DEB or gelfoam particles were equally safe. The DEB-BACE showed better survival and tumor response than C-BACE for advanced NSCLC.

Profile and methodology of ancillary protective measures employed during percutaneous renal cryoablation in a single high-volume centre

OBJECTIVES

To evaluate the at-risk organs that require protection during percutaneous cryoablation (PCA) of renal tumours and the correlation with patient and target lesion characteristics, type of protective measure used and postoperative outcomes.

MATERIALS AND METHODS

Single-centre retrospective review of patients with renal tumours who underwent PCA between 2008 and 2020. Final analysis included 374 tumours. Patient, tumour, and procedure technical details were extracted and analysed. At-risk organs were classified according to tumour location relative to kidney side, pyelic axis, and polar lines.

RESULTS

There were 171 (46.0%) tumours in the left kidney, and 194 (52.0%) in the right. Cryoprotection was required for 272 (272/374; 73.0%) tumours, with hydrodissection (216/374; 58.0%) being the most common technique. Protective measures were used for 82 (82/93; 88.0%) tumours in under/normal-weight patients and 143 (143/196; 73.0%) in overweight/obese ones (P = 0.004). In the left kidney, colon was the most common at-risk organ (63/171; 37.0%), followed by spleen (21/171; 12.3%), small bowel (21/171; 12.3%), ureter (19/171; 11.1%), abdominal wall (15/171; 8.8%), psoas muscle (10/171; 5.8%), and pancreas (9/171; 5.3%). In the right kidney, common at-risk organs were the colon (67/194; 35.0%), liver (50/194; 25.7%), ureter (15/194; 15.5%), diaphragm (16/194; 8.2%), abdominal wall (14/194; 7.2%), and duodenum (12/194; 6.1%). No cryoinjuries to at-risk organs occurred.

CONCLUSION

Hydrodissection is the most common cryoprotective measure used for renal tumour PCA. Under/normal-weight patients are more likely to require cryoprotection. The colon is the most common adjacent at-risk organ requiring protection for both right- and left-sided tumours.

The Delay of Recanalisation of Acutely Thrombosed Dialysis Arteriovenous Access Until the Next Workday has No Negative Impact on Clinical Outcome

PURPOSE

The necessity of providing endovascular recanalization of acutely thrombosed arteriovenous access (AV access) during weekend is questionable, since hemodialysis can alternatively be achieved by temporarily placed non-tunneled central venous catheters (CVC). Interventional therapy of acutely thrombosed AV access is provided only on weekdays in the study center. This study aimed to compare outcomes in patients admitted on weekdays and on the weekend.

METHODS

A total of 355 endovascular procedures for thrombosed AV access performed in a single tertiary center from 2007 to 2017 were retrospectively analyzed for technical and clinical success, complications, rate of CVC and length of hospitalization. Technical success was defined as adequate blood flow with less than 30% residual stenosis, clinical success was defined as at least one successful hemodialysis after recanalization. There were two groups: patients who had to wait at least 2 days for recanalization due to admission at the weekend (n = 59, at-the-weekend group, ATW group) and patients receiving therapy no later than the day after admission (n = 296, on a working day group, OAW group).

RESULTS

The technical/clinical success rate was 96.6%/88.1% in the ATW and 89.1%/84.6% in the OAW group (p > .05). Complications did not differ among groups (p > .05). Despite a higher rate of CVC, no attributed additional adverse events or complications were observed in the ATW group (p > .05).

CONCLUSION

Despite a longer time until treatment and a higher rate of short-term CVC, it seems to be justified to provide recanalization of dialysis shunts only during weekdays.

Percutaneous Image-Guided Cryoablation of Endometriosis Scars in Unusual Anatomic Locations

PURPOSE

To report the pain relief and procedure-related outcomes of percutaneous cryoablation (CA) of painful endometriosis deposits in unusual anatomic locations.

MATERIALS AND METHODS

A retrospective search of institutional radiological information system identified a total of 15 patients (median age 35.5 years; interquartile ranges-IQR 33-38). Patients and lesions specific data as well as procedural and follow-up information were collected, analyzed, and presented using descriptive statistical methods.

RESULTS

A total of 16 painful target lesions situated in the umbilicus (7/16; 43.8%), diaphragm (4/16; 25.0%), inguinal canal (3/16; 18.8%), and within the muscular layers of the uterus (i.e., adenomyosis; 2/16; 12.4%) underwent CA. The median of the largest diameter of the target lesions was 19 mm (IQR 13-22.3). Primary and secondary rates of complete pain relief were achieved in 86.7% (13/15 patients) and 93.3% (14/15 patients; one patient receiving additional CA for recurring pain) of patients, respectively. Each lesion underwent one single intervention, thus accounting for a total of 16 CA procedures. Eleven interventions were carried out under general anesthesia (11/16; 68.8%), with combination of ultrasound and cross-sectional imaging (CT or MRI) being the most used modality for image guidance (10/16; 62.5%). Nearly all interventions (15/16; 93.8%) required adjunctive protective measures with hydrodissection (13/16; 81.3%) and combination of hydrodissection and cutaneous protection with warm saline filled gloves (9/16; 56.3%) being the two most common protective measures. Two (2/16; 12.5%) complications were noted.

CONCLUSIONS

Percutaneous CA of painful endometriosis deposits in unusual anatomic locations seems highly effective and safe.

A Single Institution Experience with a Shear-Thinning Conformable Embolic for Endovascular Embolization

PURPOSE

To assess the safety and efficacy of Obsidio™ conformable embolic (CE) for embolization in the peripheral vasculature.

MATERIALS AND METHODS

A retrospective review of the first 21 patients treated with CE was performed. Eighteen (85.7%) patients were male, and median age was 61.5 years (range, 12-89 years). Technical success was defined as stasis as assessed by a static contrast column for at least 5 heartbeats on post-embolization angiography. For procedures of peripheral vascular hemorrhage, clinical success was defined as hemorrhage resolution without reintervention within 30-day follow-up.

RESULTS

Indications for embolization were peripheral arterial hemorrhage (n = 13), preoperative tumor embolization (n = 4), preoperative embolization of renal cell carcinoma prior to cryoablation (n = 2), redistribution of flow prior to Yttrium-90 radioembolization to prevent nontarget radiation delivery (n = 1), and parastomal variceal embolization (n = 1). Embolization was performed via 2.4 or 2.8 French microcatheters flushed with saline prior to embolization. Most procedures (20/21) utilized < 1 cc of embolic, with the quantity used ranging between 0.1 and 1.4 cc. The amount of embolic injected was determined by the embolization endpoint, i.e., filling of the vessel intended for embolization. CE was used in combination with coils placed prior to CE in 4 procedures. Follow-up was a median of 57 days (range 0-244 days). Complete stasis was achieved in 100% (n = 21/21) of procedures. There were no post-procedure adverse events or rebleeding.

CONCLUSION

CE resulted in reliable vessel occlusion with no cases of rebleeding or reintervention and with no procedure-related adverse events in this series.

LEVEL OF EVIDENCE

Level 4, Case Series.

Impact on Sexual Function of Protective Coil Embolization of Penile Collaterals During Prostatic Artery Embolization

PURPOSE

This study aims to evaluate the erectile and ejaculatory function of patients undergoing prostate artery embolization with coil embolization of penile collaterals (cPAE) compared to traditional PAE (tPAE) for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

878 patients who underwent PAE for LUTS secondary to BPH at a single institution from September 2014 to September 2022 were assessed. 828 (94%) underwent tPAE, and 50 (6%) underwent cPAE. Sexual Health Inventory for Men (SHIM) and Ejaculatory Function Questionnaire (EJQ) scores were reviewed pre-procedure and at subsequent follow-ups.

RESULTS

In tPAE, the median (interquartile range (IQR), p-value compared to baseline) SHIM scores were 19(14-24, p =  < 0.001), 19(13-18, p = 0.22), 19(16-23, p = 0.005), and 18(15-22, p = 0.52) at 3, 6, 12, and 24 months, respectively, from a baseline of 17(10-21). In cPAE, median-(IQR, p-value compared to baseline) SHIM scores were 16(6.5-22.5, p = 0.03), 13(6.8-16.3, p = 0.04), 8.5(5-1.5, p = 0.46), and 18(15-18, p = 1) at 3, 6, 12, and 24 months, respectively, from baseline of 13 (8-20). There was no significant difference in SHIM score change from baseline between cPAE and tPAE groups at 3(p = 0.60), 6(p = 0.31), 12(p = 0.09), and 24 months(p = 1) post-PAE. In tPAE, median(IQR, p-value compared to baseline)-EJQ scores were 16(13-18, p = 0.42), 16(13-18, p = 0.22), 17(12-19, p = 0.09), and 16(12.5-19, p = 1) at 3, 6, 12, and 24 months, respectively, from baseline of 14 (11-18). In cPAE group, median EJQ scores were 14(10.5-20, p = 0.11), 18(17-18), 16.5(3.5-19.7, p = 1) at 3, 6, and 12 months, respectively, from baseline of 15(12-18). There was no significant difference in EJQ score change from baseline between cPAE and tPAE groups at 3(p = 0.26), 6(p = 0.38), and 12(p = 0.88) months.

CONCLUSION

Adjunct coil embolization of penile collaterals during PAE for preventing nontarget embolization has no adverse effect on erectile or ejaculatory function.

Long-Term Results of Modified Catheterization Technique in the Treatment of CE Type 2 and 3b Liver Hydatid Cysts

PURPOSE

To evaluate the long-term results of modified catheterization technique (Mo-CAT) for percutaneous treatment of liver CE2/CE3b hydatid disease in a large series.

MATERIALS AND METHODS

A total of 119 patients (F/M:73/59) and 132 liver CE2 and CE3b cysts who underwent percutaneous treatment by Mo-CAT from 2009 to 2020 were included in the study. Patients' age ranges from 8 to 78 years (mean: 39 years). Volume changes of all cysts after the procedure, success and complication rates, duration of hospital stay, catheterization time and recurrence rates were recorded. Technical success was defined as successful catheter introduction into the CE. Clinical success was defined as cases with no mortality and no recurrence.

RESULTS

Among all patients, the mean reduction in the cyst volume was 65.84% (range 6.29-100%). The mean length of hospital stay was 3.88 ± 4.73 days (range 1-36 days). A total of 107 (89.9%) of 119 patients were discharged from the hospital in first the week after the procedure. Major complications were observed in 12 of 119 patients (10.08%) and 12 out of 132 cysts (9.09%). Recurrence was detected in 6 (4.5%) cysts in 6 patients (4.5%) who needed additional procedures. Among all 119 patients, the mean follow-up duration was 51.66 ± 35.56 months (median, 49.00 months; range 0-131 months).

CONCLUSIONS

Treatment of liver CE2/3b with Mo-CAT appears to be a safe, reliable and efficient technique which is associated with low recurrence and complication rates.

Direct epidural ethanol injection in aggressive vertebral hemangiomas to decompress the central canal: a multistep percutaneous treatment strategy

BACKGROUND

Vertebral hemangiomas are incidental and typically, asymptomatic lesions of the spine, present in 10-12% of the population. However, aggressive vertebral hemangiomas (AVHs) can compromise the spinal canal, leading to spinal cord or nerve root compression, and require timely treatment to prevent permanent neurological deficits. Surgical management is challenging owing to the high vascularity of AVHs, and carries a significant risk of perioperative blood loss. Intraosseous ethanol injection is commonly used for sclerotization, but may not adequately deal with epidural components.

OBJECTIVE

To carry out a staged treatment with an image-guided puncture and ethanol injection of the epidural component in 12 patients.

METHODS

We retrospectively analyzed 12 patients with symptomatic AVHs who underwent targeted epidural ethanol injection followed by vertebral body cement augmentation, between 2017 and 2024, at three tertiary hospitals. Data collection included pre- and post-treatment imaging and clinical outcomes.

RESULTS

Among 12 patients (mean age 50, women 50%), all had extensive epidural involvement and were symptomatic, including spinal cord compression and pain. Reduction in size of more than 75% of the epidural hemangioma was achieved in 8 cases, with 11 patients experiencing complete symptom resolution. Laminectomy was performed in 3 cases, while corpectomy was avoided in all cases. Two patients had neurological worsening, with one achieving complete resolution and the other having mild residual impairment after rehabilitation due to a small spinal cord ischemic lesion. No other major complications occurred.

CONCLUSION

Direct epidural ethanol injection provides a minimally invasive alternative to surgery, such as corpectomy, including rapid size reduction of the compressive epidural component, and potentially, prevents retrograde flow into arterial collaterals. Adding vertebroplasty enhances vertebral stability.

Efficacy of ultrasound-guided microwave ablation for vascular malformations in children

OBJECTIVE

The aim of this study was to report our center's experience in treating pediatric vascular malformations using ultrasound-guided microwave ablation.

METHODS

Twenty-two symptomatic children with vascular malformations underwent ultrasound-guided microwave ablation. All patients received ultrasound follow-up after microwave ablation, whereas magnetic resonance imaging follow-up was conducted depending on the disease's condition. The Visual Analog Scale and the PedsQL4.0 Chinese Version was utilized to assess the changes in pain severity, limb motion evaluation, and quality of life before and after treatment.

RESULTS

The study included 22 cases, comprising four arteriovenous malformations, nine venous malformations, two diffuse microcystic lymphatic malformations, two cases of Klippel-Trenaunay syndrome, and five cases of fibro adipose vascular anomaly. All children presented with pain at the affected site (22 cases; 100%). The malformations were located in the limbs in 17 cases (77%), subcutaneous and intramuscular tissues of the buttocks in one case (4.5%), subcutaneous tissue of the abdominal wall in one case (4.5%), and retroperitoneal in three cases (14%). All 22 patients (100%) experienced pain. Additionally, 20 cases (91%) exhibited swelling at the affected site or developed swelling after physical activity. Limb hypertrophy was observed in five cases (23%), whereas another five cases (23%) showed signs of limb atrophy. Joint mobility restrictions were present in four cases (18%). Among these 22 patients, 17 cases (77.3%) experienced complete resolution of pain and local lesion appearance changes, whereas four cases (18.2%) reported pain relief. However, in one case (4.5%) of Klippel-Trenaunay syndrome, postoperative improvement was observed at the treatment site, but a new centripetal malformation developed within the treated region. This patient subsequently underwent surgical intervention, resulting in an improvement in clinical symptoms. The pre-treatment malformation volume was 209.85 ± 343.17 cm3, which reduced to 32.95 ± 66.04 cm3 1 year after ablation. The volume reduction was statistically significant (t = 2.374; P = .026; P < .05), with an average volume reduction rate of 85.51%. No major complications were found, such as nerve damage or skin burns.

CONCLUSIONS

Ultrasound-guided microwave ablation is a relatively safe and effective technique for treating pediatric vascular malformations. Further multicenter studies are recommended to validate these findings.

Transarterial chemoembolization for unresectable hepatocellular carcinoma: a comparative study between transradial and transfemoral approaches

Background

While transarterial chemoembolization (TACE) has been performed using both the transfemoral approach (TFA) and the transradial approach (TRA) to date, the relative superiority of these techniques remains uncertain. This study aimed to evaluate the relative clinical efficacy, radiation exposure, and safety associated with TRA- and TFA-based TACE procedures in patients with inoperable hepatocellular carcinoma (HCC).

Methods

This study compared the relative outcomes of consecutive inoperable HCC patients who were treated via TFA- or TRA-based TACE between January 2020 and August 2024.

Results

This retrospective analysis included 83 HCC patients, of whom 41 and 42 respectively underwent TFA- and TRA-based TACE. Both of these approaches were associated with technical success rates of 100%. The mean TACE duration in the TRA group was significantly shorter than that in the TFA group (57.4 ± 23.5 vs. 73.5 ± 23.3 min, P = 0.002), whereas both groups exhibited a similar median fluoroscopy time (14 min vs. 13 min, P = 0.415) and radiation dose (159 Gy.cm2 vs. 160 Gy.cm2, P = 0.946). Two patients in each group experienced puncture site hematomas (4.9% vs. 4.8%, P = 1.000). While patients in the TFA group required ≥ 20 h of postoperative bed rest, the same was not true for patients in the TRA group.

Conclusion

TRA- and TFA-based TACE are both safe and feasible approaches to treating inoperable HCC patients. Relative to the TFA-based approach, the TRA-based approach entails a significantly shorter arterial compression time and requires less postoperative bed rest.

Embolization of ruptured pancreaticoduodenal arcade aneurysms due to median arcuate ligament without celiac artery revascularization: a single-center experience and literature review

BACKGROUND

The aim of this single-center retrospective study is to evaluate the feasibility, complications, and outcomes of transarterial embolization (TAE) for ruptured pancreaticoduodenal arcades aneurysms (PDAAs) due to median arcuate ligament (MAL), without subsequent revascularization of celiac artery (CA) occlusion/stenosis.

METHODS

Between January 1st 2012 and June 1st 2024, all records from adult patients (≥ 18 years old) referred to our hospital for TAE due to ruptured PDAAs were retrospectively reviewed. All referrals were based on emergency clinical decisions and computed tomography. Procedure data included procedure, type of embolic agent and per-procedural complication. TAE technical success was defined as the cessation of aneurysm opacification immediately after the TAE, based on angiographic findings. Overall technical success was defined as the cessation of aneurysm opacification after TAE or percutaneous salvage approach during the same session. Then, we analyzed all published original articles published between January 2007 and December 2024 on emergency TAE of ruptured PDAAs due to MAL, without subsequent treatment of CA stenosis/occlusion.

RESULTS

Nine patients (4 males) were referred for TAE for ruptured PDAAs due to MAL in our center. TAE technical success was achieved in 7/9 patients, and overall technical success was achieved in all patients. There were no major complications. No patients had rebleeding during follow-up. We reviewed four retrospective studies including 29 patients treated for ruptured PDAAs due to MAL without subsequent treatment of CA stenosis/occlusion. No patient received additional treatment for CA stenosis/occlusion. No aneurysm recurrence was diagnosed during the reported follow-up periods ranging from 1 to 65 months.

CONCLUSION

TAE for ruptured PDAAs without CA revascularization is safe and should be considered, although further studies are required to validate its validity and long-term outcomes.

Coils associated with micro vascular plug system for closing larger vessels: Technical note on a preliminary experience

ObjectivesThe MVP™ Micro Vascular Plug System represents a plug indicated for embolisation of peripheral vasculature. It has a lower profile and can be deliverable through smaller catheters, but it can occlude vessels ≤9 mm. We propose a new embolisation technique based on the use of the MVP™ and detachable coils to embolise vessels of larger calibre.Materials and methodsThrough a 7-F sheath the plug is implanted without detaching it. Then, the vessel is navigated in parallel with a microcatheter through which some coils are detached using the bare portion of the MVP™ to anchor them. This will stabilise the plug avoiding its distal migration. We performed vessel embolisation using this technique in two patients.ResultsTechnical success was 100% with no complications. No MPV™ migration was observed after one month.ConclusionsIn selected cases, this technique allows to expand the indications of the MVP™ when it is undersized to the calibre of the vessel.

Genicular Artery Embolization in Moderate to Severe Knee Osteoarthritis: Technique, Safety and Clinical Outcome

PURPOSE

To evaluate the safety and clinical outcomes of genicular artery embolization for knee osteoarthritis (OA).

MATERIALS AND METHODS

A total of 43 patients suffering from osteoarthritis of the knee (Kellgren and Lawrence grades 2-4) were included in this prospective study. Peri-interventional data including vascular access, embolized target vessels, fluoroscopy time and radiation dose were collected. After 2-, 3- and 12-month pain scores, functional outcomes and adverse events were assessed through a standardized questionnaire.

RESULTS

All embolizations were performed via a coaxial system consisting of a 4F Cobra catheter and a Microcatheter without the use of an introducer sheath. A mixture of contrast agent (Accupaque, GE, USA) and microspheres (Embosphere, Merit Medical, USA) was injected. At least three genicular branches were embolized per patient with following incidence: inferior lateral genicular artery (77%), superior lateral genicular artery (74%) and descending genicular artery (74%). The mean total volume of permanent embolic agent used was 3.6 ± 1.3 ml. The average fluoroscopy time was 29 ± 11 min, and radiation dose was 40.84 ± 26.21 Gy/cm2. During the 1-year follow-up, patients pain while walking showed an average reduction of 2.0 ± 0.5 points on the numeric rating scale (p < 0.0001), without any significant difference between different grades of osteoarthritis. Besides mild transient skin discolorations in four patients, no complications were observed.

CONCLUSION

Embolization of multiple genicular artery branches in a single session using microspheres in averaged doses higher than 2 ml total is safe and effective in reducing pain and improving functionality in patients with symptomatic OA, regardless of severity grade.

Diagnostic yield and complications of CT-guided biopsy of lung lesions as a radiological outpatient clinic procedure

Background

Computerized tomography-guided transthoracic needle biopsy (CT-TTNB) plays an important role in the diagnostic work-up of lung lesions. The literature reports varying results on complication rates, severity of complications, and diagnostic yield.

Purpose

To evaluate CT-TTNB as a radiological outpatient clinic procedure and explore diagnostic yield and complication rates.

Material and methods

Between January 2017 and October 2019, a total of 559 patients underwent CT-TTNB. Patient records and CT scans were retrospectively reviewed and patient characteristics, lesion characteristics, biopsy procedure, and per- and post-procedural complications, as well as pathological diagnosis, were registered.

Results

Of 559 patients included, 511 had biopsies performed. Thereby, 48 biopsies (8.6%) were discontinued because of patient compliance issues and/or the occurrence of pneumothorax before the biopsy was performed. The overall pneumothorax rate was 49.2% (n = 275 of 559 patients). Insertion of a drainage catheter was needed in 85 of the 275 patients with pneumothorax. Parenchymal bleeding was seen in 26.5% of the patients and haemoptysis in 5.5%. No cases of bleeding or haemoptysis required intervention or admission. Small mean lesion size and increased distance from pleura to the lesion were associated with a higher occurrence of complications. A conclusive pathological diagnosis was obtained in 278 of 511 (54.4%) biopsies. No patients were re-admitted after the two-hour observational period in the radiological department.

Conclusion

CT-TTNB as an outpatient clinic procedure is feasible but has a moderate diagnostic yield and relatively high complication rates for minor complications.

Safety and Efficacy of Portal Vein Recanalization with Creation of Intrahepatic Portosystemic Shunt (PVR-TIPS) to Treat Chronic Portal Vein Thrombosis in Non-cirrhotic Patients

PURPOSE

This study assesses the efficacy and safety of Portal Vein Recanalization with Intrahepatic Portosystemic Shunt (PVR-TIPS) in non-cirrhotic patients with chronic portal vein occlusion (CPVO), cavernomatous transformation, and symptomatic portal hypertension (PH) and/or portal vein thrombotic progression.

MATERIAL AND METHODS

Medical records of 21 non-cirrhotic patients with CPVO and portal cavernoma undergoing PVR-TIPS were analyzed. Hemodynamic (intraprocedural reduction in portosystemic pressure gradient), clinical (data on gastrointestinal bleeding, abdominal pain, ascites, and presence of esophageal varices from imaging exams) and technical success (PVR-TIPS) assessed efficacy. Safety was determined through complications classified according to the CIRSE Classification System.

RESULTS

PVR-TIPS was successfully performed in all patients, resulting in a significant reduction in portal pressure gradient by 10 mmHg (21.475 ± 9.7 mmHg - 11.454 ± 5,4 mmHg, p < 0.001), alleviating portal hypertension symptoms without thrombotic progression. Clinical success included resolution or reduction of ascites (p = 0.016), gastroesophageal varices (p = 0.004), abdominal pain (p = 0.0021), and cessation of gastrointestinal bleeding (p = 0.021). Complications occurred in 33% of patients, including six grade III events (1 perioperative liver bleeding, 5 delayed stent occlusions) and one grade VI event resulting in death (4.8%). Primary patency rate was 76% (21.3 months, range:0.2-82), secondary patency 100% (4 months, range:3.8-40.8). Survival at follow-up was 90.4%, with one unrelated death. One patient underwent liver transplantation, three became eligible post-recanalization.

CONCLUSION

PVR-TIPS proves effective and safe in reducing portal pressure gradient, thereby alleviating PH symptoms without evidence of portal thrombosis progression in non-cirrhotic patients with CPVO and portal cavernoma. It expands therapeutic options, including liver transplantation.

Stability of Thermoablation Antenna Using a Patient-Mounted Navigation System: Initial Clinical Experience

PURPOSE

CT-guided microwave ablation (MWA) has become a standard procedure for a range of therapeutic and diagnostic indications, but accurate and stable positioning of the antenna is critical. In this retrospective case series, a navigation guide with a physical cube component, the Access Cube (AC), was investigated as a stability support in addition to its use as a navigation system. To our knowledge, this is the first investigation of stability in MWA.

MATERIALS AND METHODS

Eight MWAs performed at one centre using the AC were reviewed for clinical and technical success. The stability of the antenna was assessed by subjectively comparing the Euclidian distance (ED) between the needle tip location in the final control scan and confirmation scan. A practising radiologist not associated with the study independently assessed the coordinates, and the mean was calculated from the results.

RESULTS

Six patients (eight procedures) were included (4 females). Mean age of the patients was 75.8 years (range 58-87). Diagnoses included liver metastasis (4, 50%), renal cell carcinoma (2, 25%) and 1 case each (12.5%) of hepatocellular carcinoma and lung metastasis. Mean tumour size was 2.4 cm (range 1.0-4.3 cm), with a mean depth of 10.6 cm (range 5-18 cm). Mean ED of needle tip between final control scan and confirmation scan was 5.82 mm. Technical and clinical success were achieved in all cases with one Grade 2 complication arising.

CONCLUSION

Usage of the AC was a beneficial addition to the MWA process. Good stability of the antenna was achieved when placed through the AC, eliminating the need for the clinician to manually hold the antenna in place during ablation.

LEVEL OF EVIDENCE

Level 4, Case Series.

Hepatic Hilar Nerve Block for Adjunctive Analgesia in Thermal Ablation of Liver Tumors: A Prospective Randomized Controlled Trial

To determine whether performing a temporary hepatic hilar nerve block in patients undergoing microwave or radiofrequency ablation of primary or secondary hepatic malignancies reduces the requirement for intravenous conscious procedural sedation and analgesia.Fifty patients undergoing percutaneous image-guided liver thermal ablation were included in this single-center prospective randomized controlled trial. The experimental arm received a hepatic hilar nerve block in addition to intravenous medication directly before thermal ablation, whereas the control group underwent thermal ablation solely under intravenous medication, with the possibility of crossover. Student's t-test and analysis of covariance were performed to determine the block's efficacy regarding the intraoperative medication requirement.50 patients (22 females, 28 males) were randomly allocated to two groups without significant differences between the cohorts' baseline patient, clinical, and tumor characteristics. Three control group patients underwent crossover. Initial analysis using Student's t-test revealed no significant intravenous medication reduction in the control group vs. the test group (190 µg vs. 189 µg fentanyl, P = 0.96 and 1.34 mg vs. 1.60 mg Midazolam, P = 0.19). Thus, ANCOVA was performed to accommodate for heterogeneous ablation conditions (ablation time, total energy applied, affected liver capsule area). The adjusted mean fentanyl dosage was 206 µg vs. 184 µg (control group vs. test group), yielding a significant reduction after block (P = 0.020). None of the patients who received a hepatic hilar nerve block experienced any adverse events during a mean follow-up of nearly six months (range: 0-17 months).This prospective randomized trial confirms that a hepatic hilar nerve block can be safely performed before liver tumor thermal ablation as an adjunct to intravenous medication to reduce opioid consumption and manage pain. · First randomized study evaluating hepatic hilar nerve block (HHNB) for liver tumor ablation.. · HHNB significantly reduced opioid use after adjusting for heterogeneous ablation conditions.. · The effect is less pronounced than in retrospective studies. Larger trials are needed.. · Georgiades M, March C, Barajas Ordonez F et al. Hepatic Hilar Nerve Block for Adjunctive Analgesia in Thermal Ablation of Liver Tumors: A Prospective Randomized Controlled Trial. Rofo 2025; DOI 10.1055/a-2528-7037.

Triple coaxial microcatheter for preoperative transcatheter arterial embolization in bone and soft tissue tumors

BACKGROUND

Preoperative transcatheter arterial embolization (P-TAE) is a procedure designed to reduce intraoperative blood loss (IBL) and support the performance of surgery for bone and soft tissue tumors (BSTT).

PURPOSE

To develop a new P-TAE technique using a triaxial microcatheter system (TMCS) that maintains normal tissue circulation while embolizing only the feeding artery of BSTT and to investigate the safety and efficacy of P-TAE with TMCS.

MATERIAL AND METHODS

A total of 34 cases of BSTT in the whole body (25 men, nine women; mean age = 74.85 ± 11.32 years) were included between 1 April 2014 and 30 June 2024. We evaluated technical and clinical outcomes, P-TAE techniques, complications, and patient characteristics.

RESULTS

Bone metastasis of renal cell carcinoma (n = 11) was the most frequent diagnosis. P-TAEs using TMCS were performed with technical success (97.05%) and clinical success (88.23%), demonstrating a high selectivity rate to the feeding artery of 97.14%. The mean IBL was 792.70 ± 1285.61 mL (median = 370 mL; range = 50-6935 mL). All surgeries were performed successfully after P-TAE.

CONCLUSION

P-TAE plays an important role in the presurgical operation of BSTT. The use of TMCS offers high selectivity, trackability, and crossability in the P-TAE procedure, enhancing the clinical efficacy of P-TAE.

Anatomic sub-segmentectomy with single-session combined transcatheter arterial embolization/microwave ablation for the treatment of hepatocellular carcinoma: preliminary results

PURPOSE

This retrospective study aimed to confirm the safety and long-term efficacy of a single-session combined treatment approach with transcatheter arterial embolization (TAE) and microwave ablation (MWA) for inoperable small-to intermediate-sized hepatocellular carcinomas (HCC), focusing on their combined benefits for improving local control.

MATERIALS AND METHODS

All consecutive patients with up to 2 small-to-intermediate HCC lesions (≤ 5 cm) treated with a combined single-session MWA-TAE approach were enrolled between April 2020 and October 2023. All procedures were performed in two stages: TAE and MWA. Clinical and radiological follow-up was performed 3, 6, and 12 months after treatment.

RESULTS

In the 21 enrolled patients (15 males, mean age 75.9 years), post-procedural contrast-enhanced CT scans confirmed a satisfactory ablation zone in all patients (100%), with minor peri-procedural complications reported in three patients (14%). At the last 12-month follow-up, one patient (8%) displayed local tumor progression, previously classified as LR-TR equivocal at the 6-month follow-up, and half of the patients (6 patients, 50%) exhibited distant tumor progression, predominantly in the form of intra-hepatic recurrence.

CONCLUSION

The combined approach of TAE and MWA is a promising method to enhance the percutaneous treatment of small to intermediate-sized HCCs with a resulting anatomic ablation area resembling a surgical sub-segmentectomy. This technique can potentially reduce the gap between percutaneous treatment and liver resection outcomes, allowing for a safe and effective option for oncological control in patients with > 3 cm lesions.

Percutaneous Embolization for Painful Varicocele: An 8-Year Tertiary Centre Experience

Background: Varicocele is a common condition in men that can lead to several clinical problems. Treatment modalities include surgical and non‑surgical methods. There has been no randomized controlled trial proving the superiority of one treatment approach over another. Materials and methods: We conducted an 8‑year retrospective analysis of varicocele embolization procedures at our department of Interventional Radiology. Demographic data, procedure details, procedure success and complications were collected. Telephone interviews were also conducted at the time of the study. Results: A total of 182 interventions were performed. Median age of patients at presentation was 31 years (range, 12-71). Median follow‑up duration was 44.5 months (range, 3.4-106.9). Employed embolic agents were coils in 171/182 (91.94%) cases. Technical success rate was 88.15%. Ultrasonographic success was accomplished in 44.87% patients. Clinical success rate in patients referred for scrotal pain was 70.42%. Fluoroscopy time was 20.3 ± 14.9 min (mean ± SD), dose area product was 63.2 ± 50.5 Gy∙cm² (mean ± SD) and kinetic energy released per unit mass was 193.2 ± 173.6 (mean ± SD). Minor complications were encountered in 19/182 (10.45%) of the interventions. Conclusions: Varicocele embolization was found to be an efficient and safe procedure for patients referred for scrotal pain. Randomized controlled trials are warranted to elaborate treatment algorithms in varicocele patients.

Post-closure Technique for Access Hemostasis During Emergency Endovascular Repair in Ruptured Abdominal Aortic Aneurysms: Technical Note on a Preliminary Experience

PURPOSE

To describe the downsizing post-closure technique for access hemostasis during emergency endovascular repair (EVAR) in ruptured abdominal aortic aneurysms (RAAA).

MATERIALS AND METHODS

A cohort of eight patients underwent emergency EVAR through 16 femoral access sites for infrarenal RAAA. The downsizing post-closure technique, which involves a reduction in the size of the large-bore access by advancing a 10F sheath, was consistently applied. Technical success was defined as complete hemostasis without a bailout intervention. Primary outcome measure was the incidence of access-related complications. Secondary outcome measures included manual compression time, hemostasis time, hospital stay, additional use of Proglide, and the 30-day mortality rate.

RESULTS

The technique resulted in a 100% success rate (mean age: 69.5 ± 11.7 years; 75% males). The mean arterial sheath size was 18.1 ± 1.9F. The mean manual compression time was 3.6 ± 1.2 min, and the mean hemostasis time was 6.8 ± 1.4 min. No patients required additional use of Proglide, and no access-related complications were observed. The 30-day mortality rate was 12.5%.

CONCLUSIONS

The downsizing post-closure technique may offer an alternative for access hemostasis during emergency EVAR for RAAA. However, further evaluations through larger comparative studies are required.

A Meta-Analysis and Meta-Regression of Embolisation Outcomes of Pulmonary Arteriovenous Malformations

PURPOSE

Embolisation is a widely utilised therapeutic intervention for pulmonary arteriovenous malformation (PAVM). We conducted a meta-analysis to evaluate outcomes of PAVM embolisation and factors associated with embolisation outcomes.

METHODS

MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 2000 to July 2022 on studies that assessed embolisation outcomes of PAVM. Immediate technical success rate defined as the complete occlusion of the PAVM at the time of embolisation and treatment success rate defined as ≥ 70% venous sac reduction on follow-up imaging were pooled from included studies with use of random effects proportion meta-analysis. Heterogeneity across studies was assessed with the I2 statistic.

RESULTS

Forty-four studies including 1865 patients (604 (32%) males, mean age (range) 45 (24-59) years, 1125 (60%) had hereditary haemorrhagic telangiectasia (HHT)) were included in the meta-analysis. Studies included a total of 4314 PAVMs of which 4047 (94%) were treated. Studies reported morphology of 3074 PAVMs (2519 (58%) simple and 555 (13%) complex). The pooled overall immediate technical success rate for PAVM embolisation was 99%, 95% CI (98-100%) and the treatment success rate was 86%, 95% CI (84-89%). Younger age (p = 0.041), simple PAVM (0.020), and embolisation using plugs (p = 0.001) were associated with higher treatment success. Feeding artery and sac embolisation (p = 0.021) and using coils (p = 0.001) were associated with lower treatment success. There was no significant difference in recanalisation rate between different embolisation agents (OR 0.64, 95% CI -0.09- 1.38).

CONCLUSION

This meta-analysis shows that PAVM embolisation is safe and effective. Higher treatment success rates for PAVM embolisation can be achieved using plugs as the primary embolisation agent. Embolisation agent used had no effect on recanalisation rates.

Long-Term Outcomes of the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Technique in Patients With Aorto-Iliac Occlusive Disease

BACKGROUND

The Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) reconstruction is an endovascular technique, developed to reconstruct the aortic bifurcation in the most optimal anatomical and physiological manner. Short-term data were promising, but long-term data are still lacking. The objective was to report the long-term outcomes of CERAB for extensive aorto-iliac occlusive disease and to identify predictors for loss of primary patency.

METHODS

Consecutive electively treated patients with CERAB for aorto-iliac occlusive disease in a single hospital were identified and analyzed. Baseline and procedural data and follow-up were collected at 6-weeks, 6 months, 12 months, and annually thereafter. Technical success, procedural, and 30-day complications were evaluated, as well as overall survival. Patency and freedom from target lesion revascularization rates were analyzed using Kaplan Meier curves. Uni- and multivariate analysis were performed to identify possible predictors of failure.

RESULTS

One hundred and sixty patients were included (79 male). Indication for treatment was intermittent claudication for 121 patients (75.6%) and 133 patients (83.1%) had a TASC-II D lesion. Technical success was obtained in 95.6% of patients and the 30-day mortality rate was 1.3%. The 5-year primary, primary-assisted, and secondary patency rates were 77.5%, 88.1%, and 95.0%, respectively, with a freedom-from clinically driven target lesion revascularization (CD-TLR) rate of 84.4%. The strongest predictor of loss of primary patency of CERAB was a previous aorto-iliac intervention (odds ratio [OR]=5.36 (95% confidence interval [CI]: 1.30; 22.07), p=0.020). In patients not previously treated in the aorto-iliac tract, 5-year primary, primary assisted, and secondary patency rates were 85.1%, 94.4%, and 96.9%, respectively. At 5-year follow-up, an improved Rutherford was found in 97.9% of patients and the freedom from major amputation rate was 100%.

CONCLUSION

The CERAB technique is related to good long-term outcomes, particularly in primary cases. In patients that had prior treatment for aorto-iliac occlusive disease, there were more reinterventions and therefore surveillance should likely be more intense.

CLINICAL IMPACT

The Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) reconstruction was designed to improve outcomes of endovascular treatment of extensive aorto-iliac occlusive disease. At 5-year follow-up clinical improvement was found in 97.9% of patients without major amputations. The 5-year overall primary, primary-assisted, and secondary patency rates were 77.5%, 88.1%, and 95.0%, respectively, with a freedom-from clinically driven target lesion revascularization rate of 84.4%. Significantly better patency rates were observed for patients that were never treated before in the target area. The data implicate that CERAB are a valid treatment option for patients with extensive aorto-iliac occlusive disease. For patients previously treated in the target area, other treatment options might be considered, or more intensive follow-up surveillance is warranted.

Venous Leak Embolization Results in Clinical Improvement of Patients with Mixed Arterio-Venous Erectile Dysfunction Not Responding to Arterial Revascularization Alone

PURPOSE

To analyze the safety and efficacy of additional venous leak embolization after an initial arterial revascularization to treat patients with combined arteriogenic and venogenic erectile dysfunction (ED).

MATERIALS AND METHODS

Single-center observational study from October 1, 2019, to September 30, 2022, including 26 patients with ED resistant to phosphodiesterase-5-inhibitors (PDE5i) and without significant clinical benefit after arterial revascularization of erection-related arteries. Additional treatment with venous leak embolization was performed 458 ± 424 days after arterial revascularization. Arterial obstruction and venous leak were verified based on color Doppler flow analysis, computed tomography angiography, and computed tomography cavernosography. The primary safety endpoint was any major adverse event 6 weeks after the procedure. The primary feasibility endpoint was defined as an IIEF-6 (International Index of Erectile Function-6) score improvement of ≥ 4 points at 6-week follow-up post intervention.

RESULTS

Procedural success was achieved in all patients with no major adverse events on follow-up. The primary feasibility endpoint at 6-week follow-up was reached with 3/26 (11.5%) of patients following arterial revascularization only. Six weeks after additional venous embolization, the primary feasibility endpoint was reached in 17/26 (65.4%) of patients.

CONCLUSION

Venous leak embolization yields additional clinical improvement and treatment potential in patients with vasculogenic ED not responding to PDE5i due to mixed arterio-venous disease and insufficient clinical improvement after arterial revascularization alone.

Comparing embolic particles for prostatic artery embolization to treat lower urinary tract symptoms in patients with benign prostatic hyperplasia

PURPOSE

Compare the safety and efficacy of polyvinyl alcohol particles (PVA) versus trisacryl gelatin microspheres (Embospheres) versus hydrogel microspheres coated with polyzene-F (Embozenes) for prostatic artery embolization (PAE) to treat patients with benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

A single-center prospective cohort study from 2019 to 2023, including patients with international prostate symptom score (IPSS) ≥ 15 and/or quality of life score (QoL) ≥ 4. Allocation to embolic agents was performed chronologically: 100-300 µm PVA (n = 53), followed by 300-500 µm Embospheres (n = 50), and finally, 400 µm Embozenes (n = 50). All patients were evaluated at baseline and at 1 and 6 months after PAE with IPSS/QoL; peak urinary flow rate, post-void residual volume, and prostate volume with ultrasound and prostate-specific antigen. Adverse events and the need for prostatic re-interventions were assessed.

RESULTS

There were no significant baseline differences between the three groups except for patient age (62.5 years PVA; 66.1 years Embospheres and 66.6 years Embozenes; p = 0.019). There were no major adverse events and no differences between groups regarding minor adverse events. All outcome measures improved significantly from baseline, with no significant differences between groups. Mean ± standard deviation IPSS/QoL improvement at 6 months: -10.7 ± 7.9/-2.2 ± 1.7 PVA; -10.4 ± 7.3/-2.0 ± 1.5 Embospheres; -10.4 ± 7.0/-2.2 ± 1.6 Embozenes (p = 0.987). Re-intervention rates after 6 months: 9% (n = 5/53) PVA; 14% (n = 7/50) Embospheres; 8% (n = 4/50) Embozenes (p = 0.591).

CONCLUSIONS

PAE with PVA particles, Embospheres, and Embozenes is equally safe and effective in treating BPH-related lower urinary tract symptoms.

CLINICAL RELEVANCE STATEMENT

This is the first prospective study showing equivalence between the most frequently used embolic agents for prostatic artery embolization.

KEY POINTS

Different particles can be used interchangeably for prostatic artery embolization. The improvements in measured metrics were the same between groups, with no differences in adverse events. The need for prostatic medication and re-intervention rates were the same at 1 and 6 months after embolization.

Refining MR-guided thermal ablation for HCC within the Milan criteria: a decade of clinical outcomes and predictive modeling at a single institution

BACKGROUND

The appropriateness of ablation for liver cancer patients meeting the Milan criteria remains controversial.

PURPOSE

This study aims to evaluate the long-term outcomes of MR-guided thermal ablation for HCC patients meeting the Milan criteria and develop a nomogram for predicting survival rates.

METHODS

A retrospective analysis was conducted from January 2009 to December 2021 at a single institution. Patients underwent MR-guided thermal ablation. Factors influencing progression-free survival (PFS) and overall survival (OS) were identified using univariate and multivariate Cox regression and stepwise regression. A nomogram was developed for survival prediction, followed by risk stratification and internal validation. Adverse events (AEs) were also analyzed.

RESULTS

A total of 181 patients were included, with a mean follow-up of 73.8 ± 31.7 months. The cumulative local tumor progression rates at 1, 3, and 5 years were 0.80%, 1.27%, and 1.86%, respectively. The 1-, 3-, and 5-year PFS rates were 81.8%, 57.4%, and 38.1%, and OS rates were 98.3%, 87.8%, and 62.9%. Poorer outcomes were associated with age ≤ 60 years, tumor size > 2 cm, multiple tumors, cirrhosis, proximity to major vessels, and narrow ablation margins (P < 0.05). The nomogram accurately predicted 3- and 5-year survival, and internal validation confirmed the results. AEs occurred in 33.7% of patients, with pain being the most common.

CONCLUSION

MR-guided ablation is effective for HCC patients within the Milan criteria, especially for those with smaller tumors and better liver function. The nomogram and risk stratification model are valuable tools for predicting patient outcomes and guiding treatment.

Factors influencing diagnostic yield in ultrasound-guided omental biopsies: insights from a retrospective study

PURPOSE

To evaluate the safety, diagnostic accuracy, and factors influencing the diagnostic yield of ultrasound (US)-guided omental biopsies.

MATERIALS AND METHODS

This retrospective study included 109 patients who underwent US-guided omental biopsies between June 2020 and June 2024. Pre-biopsy diagnostic images (CT, MRI, or [18 F]FDG PET/CT) were reviewed. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and adverse events were evaluated. Surgical or clinical diagnoses with follow-up served as the diagnostic reference standard. Associations between diagnostic yield and findings on pre-biopsy imaging and biopsy US were explored.

RESULTS

The study achieved a technical success rate of 100%. Initial biopsy results showed a sensitivity of 82.6%, specificity of 100%, PPV of 100%, NPV of 60.5%, and diagnostic accuracy of 86.2%. The pre-biopsy imaging modality was not related to diagnostic accuracy. Ascites interposition on the puncture route was significantly higher in patients without diagnostic accuracy (73.3% vs. 30.9%, p = 0.002). Deeper lesions exhibited lower diagnostic accuracy (p = 0.003). No major or minor complications were associated with the biopsies.

CONCLUSION

Percutaneous omental biopsy is an effective and safe method for evaluating omental abnormalities. Depth from the needle entry site and the presence of ascites along the puncture route were identified as factors affecting diagnostic accuracy. The choice of imaging modality did not impact diagnostic outcomes, highlighting the importance of lesion-specific factors in the planning of biopsies.

Lymphatic leaks - success of intranodal lymphangiogram first strategy

BACKGROUND

Lymphatic leaks are associated with significant mortality and morbidity. Intranodal lymphangiography (ILAG) involves the direct injection of ethiodised lipid into the hilum of lymph nodes. It is diagnostic procedure that can have therapeutic effects secondary to a local sclerosant effect. The aim of the study is to describe the technical and clinical success of ILAG and adjunctive lymphatic interventions performed as first line interventional techniques for lymphatic leaks refractory to conservative and medical management in a multicentre cohort of patients with symptomatic large volume lymphatic leaks.

METHODS

Multicentre retrospective study of all lymphatic interventions performed between 2017-2023 in patients with large volume lymphatic leaks (> 500 ml a day). Intranodal lymphangiography was performed initially with technical success defined as opacification of the lymphatics at the aortic bifurcation and demonstration of lymphatic leak on the index ILAG procedure or immediate post procedural CT was recorded. Lymphatic embolisation was performed with a combination of direct puncture or transvenous cannulation with glue and or coil embolisation of the thoracic duct or leak point and in cases with refractory leak. Clinical success was defined as reduction in drain output to less than 20 mL per 24 h, or no further insensible lymph leak. Time to clinical success after ILAG and adjunctive embolisation was recorded.

RESULTS

ILAG alone lead to clinical success in 14 of 32 (44%) patients after a median of 14 days. Subsequent embolisation was performed in 12 refractory cases; this was successful in 8 (67%) at median of 8 days. Overall clinical success of all lymphatic interventions was 69% (22 of 32 patients) at a median of 11 days (IQR 5-34). No statistically significant correlation between the site of leakage, aetiology or embolisation technique correlated with clinical success. Decision to proceed to repeat ILAG or an adjunct procedure was made on a clinical basis, following multidisciplinary discussion.

CONCLUSIONS

ILAG can be employed a first line interventional therapeutic technique to treat clinically significant lymphatic leaks that are refractory to conservative and medical management. Adjunctive procedures, including embolisation, can be considered as part of clinical decision making after a period of 1-2 weeks' watchful waiting in continuingly refractory cases.

Comparison of CT-Guided Microwave Ablation of Liver Malignancies with and Without Intra-Arterial Catheter Placement for Contrast Administration

BACKGROUND

The aim of this study was to compare microwave ablation (MWA) with and without prior placement of an intra-arterial catheter for the purpose of application of contrast medium (CM).

METHODS

148 patients (45 female, 65.1 ± 14.9 years) with liver tumors who underwent CT-guided MWA were included. Of these, 25 patients had an IA catheter placed in the hepatic artery.

RESULTS

37 patients underwent planning imaging for MWA without CM. A total of 86 patients received a standard dose of 80 mL intravenous (IV) CM for the planning scans. The patients with an IA catheter (n = 25) received an IA application of 10 mL CM. A total of 29 patients received contrast-enhanced scans in the PV phase for control of needle positioning after IV application of a standard dose of 80 mL CM. In patients with an IA catheter, control of the needle position was performed by single-slice scans. IA CM application during the ablation enabled monitoring of the ablation zone. Over the entire intervention, patients with IA catheters received less CM as compared to patients without an IA catheter (39.1 ± 10.4 mL vs. 141 ± 39.69 mL; p < 0.001).

CONCLUSIONS

IA catheter placement was associated with a significant decrease of the amount of CM during MWA and enabled monitoring of the ablation zone.

Effect of transarterial embolization of iatrogenic renal artery pseudoaneurysms without or with arteriovenous fistula on renal function at 6-month follow-up

INTRODUCTION

Transarterial embolization (TAE) is the gold standard treatment for iatrogenic renal artery pseudoaneurysms (PSA) and pseudoaneurysms with arteriovenous fistula (PSA + AVF), but its impact on renal function has not been sufficiently investigated. The aim of the study is to assess the impact on of TAE on renal function and its technical and clinical effectiveness.

MATERIALS AND METHODS

Sixty-seven embolization procedures in 61 consecutive patients from December 2006 to October 2020 in two centers were retrospectively reviewed for the following parameters: technical and clinical success and failure, embolization materials, type and dimensions of vascular injuries, percentage of post-procedural ischemic renal parenchyma and estimated glomerular filtration rate (eGFR) values before and 1 day after the surgical, percutaneous or endoscopic (SPE) procedure and before, 1 day after and 6 months after TAE.

RESULTS

We identified 44 PSA and 23 PSA + AVF. Technical success was 95.5%, primary clinical success was 90.2% and secondary clinical success was 96.7%. Different embolization materials were used. A significant decrease of the eGFR was found after the SPE procedure. No significant difference was found between eGFR before and after TAE. A minimal significant improvement of the eGFR was found 6 months after TAE. Embolization of larger lesions resulted in larger post-procedural ischemic areas. PSA + AVF were significantly larger (p = 0.0142) and determined a larger post-procedural ischemic area. No correlation was found between dimensions, kind of vascular injury or post-procedural ischemic area and eGFR.

CONCLUSION

TAE has high technical and clinical success rates and does not affect renal function negatively, regardless of dimensions or kind of vascular injuries or post-procedural ischemic area.

Results of a hemodialysis vascular access routine ultrasound surveillance protocol and frequency of surveillance guided pre-emptive access maintenance interventions

BACKGROUND

To evaluate the implementation of routine surveillance using ultrasound on hemodialysis vascular access (VA) outcomes and determine the number and frequency of corrective, surveillance-guided procedures performed.

METHODS

Multicenter, prospective, observational study that includes consecutive hemodialysis patients receiving therapy from native arteriovenous fistulae (AVF) or grafts (AVG). Participants were assigned to a routine VA Color Doppler ultrasound surveillance (DUS) protocol from January 2019 to December 2021. Patients were referred for corrective procedures (endovascular or surgical) based on clinical or DUS findings (pre-emptive procedures; PEP). Primary endpoint was the estimation of primary unassisted (PUP) and secondary patency (SP) rates. Secondary endpoints were the determination of the number and frequency of PEP and VA survival rates.

RESULTS

In total, 223 patients with 243 VA (192 AVF and 51 AVG) were included. Access PUP and SP rates were 83% and 93% at 12 months, 75% and 88% at 24 months, and 72% and 83% at 36 months follow-up. Autologous fistulae PUP and SP were 89% and 96% at 12 months, 81% and 93% at 24 months, and 80% and 89% at 36 months, respectively. Graft PUP and SP were 56% and 80% at 12 months, 44% and 65% at 24 months, and 39% and 54% at 36 months, respectively. In total, 56 corrective procedures (38/56 PEP; 65.5%) were performed (0.13 procedures/year), of which 34 were in AVF patients (0.09 procedures/year) and 22 in AVG patients (0.40 procedures/year). Overall, 33 VA losses occurred (0.06 failures/year), 17 in AVF (0.04 failures/year), and 16 in AVG patients (0.20 failures/year).

CONCLUSION

The use of DUS resulted in the timely diagnosis of dysfunction, satisfactory overall VA survival, and patency rates, with a low PEP frequency. Randomized controlled trials are required to establish the value of DUS surveillance on access patency and whether DUS-guided interventions could improve VA outcomes.

Ultrasound-guided percutaneous thrombin injection for the management of upper extremity pseudoaneurysms: 20 years of tertiary care center experience

PURPOSE

To evaluate the safety and efficacy of ultrasound-guided percutaneous thrombin injection for the treatment of upper extremity pseudoaneurysms.

METHODS

An institutional database containing 8,316,467 radiology reports was searched for suitable cases over a 241-month period. Fourteen female and 10 male patients, average age of 69.7 years (range 29-93) underwent a total of 26 procedures for the management of upper extremity pseudoaneurysms, involving the radial (n = 9), brachial (n = 9) or other upper extremity arteries (n = 6). Baseline demographic and pseudoaneurysm characteristics were documented, together with primary and secondary success, failures, and complications. All procedures were performed with real-time ultrasound guidance.

RESULTS

The mean pseudoaneurysm volume was 9.93 cm3 (range 0.06-111.62 cm3). Twelve cases were related to central line placement or arterial access. Primary success was obtained in 50% (n = 12) after a single ultrasound-guided thrombin injection, and secondary success was achieved in an additional six (for a total success of 75%). Success was highest for the treatment of brachial artery pseudoaneurysms (87.5%), and in those who were diagnosed within 7 days of the inciting event, findings that were statistically significant (p-value 0.046 and 0.002, respectively).

CONCLUSIONS

Ultrasound-guided percutaneous thrombin injection is safe and effective for managing upper extremity pseudoaneurysms.

Endovascular Treatment of Malfunctioning Dialysis Fistulas: A Multicenter Retrospective Analysis Comparing Transradial and Conventional Transvenous Access

BACKGROUND

Venous outflow is the favored access for endovascular management of dialysis fistulas. However, transradial access (TRA) offers advantages in specific clinical scenarios. The study aims to compare the efficacy, feasibility, and safety of TRA and transvenous access (TVA) in the endovascular management of malfunctioning dialysis fistulas, addressing the existing gap in comprehensive literature.

METHODS

A retrospective multi-center analysis included prospectively collected data (January 2021-November 2023) from patients undergoing endovascular management of malfunctioning dialysis fistulas with TRA. Control groups comprised patients with TVA.

RESULTS

Of 206 patients, 62 underwent TRA, and 144 underwent TVA. Baseline demographics showed a well-matched distribution. TRA exhibited longer cannulation times but similar procedural and fluoroscopy times. Technical success rates were high for both TRA (98.4%) and TVA (97.2%). Clinical success rates were comparable (96.8% vs. 95.8%). Postprocedure access flow rates and complications demonstrated no significant differences.

CONCLUSIONS

This study provides the first direct comparison of TRA and TVA in malfunctioning dialytic fistulas. While venous outflow remains the standard vascular access site for managing malfunctioning dialysis fistulas, TRA shows comparable efficacy, safety, and feasibility, making it a viable alternative in specific clinical contexts. Further studies are needed to confirm these findings and to determine the long-term durability of TRA.

The Efficacy and Safety of a Microwave Ablation System with a Dipole Antenna Design Featuring Floating Sleeves and Anti-Phase Technology in Stereotactic Percutaneous Liver Tumor Ablation: Results from a Prospective Study

Purpose: To evaluate the efficacy and safety of the Surgnova Dophi™ M150E microwave ablation system in a prospective single-center observational study. Methods: A cohort of 50 patients with 77 primary or secondary liver tumors underwent CT-navigated stereotactic percutaneous microwave ablation with curative intention using the Surgnova Dophi™ M150E system. The endpoints were primary technique efficacy (PTE), number of complications, ablation defect dimensions, and sphericity index compared to previously reported findings. Results: The PTE was 97.4%, with complete ablation in 75 out of 77 tumors. Complications occurred in 10% of patients, with 4% classified as major. A comparison with previous in vivo data confirmed the reliability of the system in achieving reproducible and predictable ablation results. Conclusions: Stereotactic percutaneous microwave ablation with the Surgnova Dophi™ M150E system is safe and effective for liver tumor treatment.

Stereotactic Percutaneous Electrochemotherapy as a New Minimal Invasive Treatment Modality for Primary and Secondary Liver Malignancies

Background and Objectives: To report on the first results of safety, efficacy, and outcome of CT-navigated stereotactic percutaneous electrochemotherapy (SpECT) in patients with primary and secondary liver malignancies. Methods: This retrospective study included 23 consecutive lesions in 22 patients who underwent SpECT for primary and secondary malignant liver lesions with locally curative intention. The endpoints were primary technique efficacy (PTE), local tumor progression (LTP), time to progression (TTP), and occurrence of adverse events. Results: The mean maximum diameter of the treated lesions was 42 mm (range: 16 mm-72 mm). Eight lesions were hepatocellular carcinoma (34.8%), five lesions were colorectal liver metastases (21.7%), three lesions were cholangiocellular carcinoma (13.0%), and the other seven lesions were liver metastases from different primary cancers (30.4%). PTE was achieved for 22 lesions (95.7%). The mean follow-up time was 15 months (0-39 months). No LTP was observed. In six patients (27.3%), hepatic tumor progression was observed during follow-up with a mean TTP of 3.8 months (2-8 months). In 10 procedures (43.5%), minor complications (1 CIRSE Grade 2) and side effects occurred, but no major complications were observed. Conclusions: SpECT seems to be a safe and effective new local treatment modality for primary and secondary liver malignancies.

Clinicopathological Evaluation of Postpancreaticoduonenectomy Hemorrhage with Endovascular Treatment

INTRODUCTION

Postpancreaticoduodenectomy hemorrhage (PPH) is a serious complication. Fatty or nonfibrous pancreas, or both, is a risk factor for pancreatic fistula. This study assessed various prognostic factors for interventional procedures for PPH, also focusing on the degree of pancreatic fatty infiltration/fibrosis evaluated histopathologically.

MATERIAL AND METHODS

The participants were 29 patients with PPH who underwent endovascular treatment from September 2001 to March 2020. Univariate analysis was performed to determine whether the histopathological degree of pancreatic fatty infiltration/fibrosis and other factors were associated with complications and mortality after endovascular treatment for PPH.

RESULTS

Of 39 treatment sessions overall, 38 (97%) achieved technical success and 34 (87%) had clinical success. In-hospital mortality occurred in five patients (17%). No association was found between the pancreatic fistula and the histopathological degree of pancreatic fatty infiltration/fibrosis. Fourteen patients with hemorrhagic shock before endovascular treatment included all five patients with in-hospital mortality, while the 15 patients without hemorrhagic shock survived (P = 0.017). A bleeding tendency was associated with complications after endovascular treatment for PPH (P = 0.033).

CONCLUSIONS

Although our results revealed no significant relation between the histopathological degree of pancreatic fatty infiltration/fibrosis and clinical success, including prognosis, endovascular treatment may be effective for PPH.

Is ultrasound-guided radiofrequency ablation a reliable treatment option for unifocal T1aN0M0 papillary thyroid carcinoma in the isthmus: a retrospective comparative study based on large-sample data

OBJECTIVE

To evaluate whether ultrasound-guided radiofrequency ablation (RFA) is reliable for unifocal T1aN0M0 papillary thyroid carcinoma in the isthmus (PTCI).

METHODS

431 patients who underwent ultrasound-guided RFA for unifocal T1aN0M0 papillary thyroid carcinoma (PTC) were divided by location of the lesion into the PTCI group (52 females, 7 males, mean age 43.79 ± 12.04 years, range 22-74 years) and the PTCL group ((291 females, 81 males, mean age 43.42 ± 10.87 years, range 18-75 years) for comparative analysis. The efficacy of ultrasound-guided RFA was evaluated by volume reduction rate (VRR), complete disappearance rate (CDR) and disease progression, and the safety was evaluated by incidence of complications.

RESULTS

The two groups exhibited a consistent trend of change, with the PTCI group performing better in volume, VRR and CDR at all follow-up time points expect 1 month, but the differences were not statistically significant (p > 0.05). The mean initial volume of the PTCI group vs the PTCL group decreased significantly from 65.4 ± 69.79 vs 86.38 ± 87.09 mm³ (range 10.92-427.58 vs 3.05-471.6 mm³) to 0 vs 0 mm³ at a mean follow-up time of 31.12 ± 12.5 months (range 12-60 months); their VRR increased significantly from -618.62 ± 655.61% vs -789.85 ± 1135.07% at 1 month to 100% vs 100% at 48 months. No disease progression was found in the two groups. The PTCI group had no complications, whereas the PTCL group had a total of 7 complications (1.88%).

CONCLUSIONS

Ultrasound-guided RFA is reliable for unifocal T1aN0M0 PTCI. It can be promoted as an alternative to immediate surgery for selected PTC patients.

Differences in Management and Outcomes in Atraumatic Splenic Rupture Compared to Traumatic Injury Following Blunt Abdominal Trauma

Background/Objectives: To evaluate the differences in treatment and outcomes between traumatic and atraumatic splenic lacerations. Methods: This retrospective study included all patients with a diagnosis of splenic lacerations confirmed by computed tomography that presented from 01/2010 to 03/2023 at one tertiary hospital. The exclusion criteria included missing image data and death in the first 24 h due to extensive trauma. The etiology of the splenic laceration, demographic characteristics, and clinical parameters were recorded and evaluated as prognostic factors in therapy success and mortality. Subgroup analyses were undertaken according to the etiology of the splenic laceration and the primary treatment. The extent of splenic laceration was assessed by using the American Association for the Surgery of Trauma (AAST) score in its latest revision (2018). Results: Of all 291 enrolled patients (mean age 47 ± 21 years, 204 males), 50 presented with atraumatic splenic lacerations due to different underlying causes. The occurrence of moderate and high-grade laceration differed significantly between the atraumatic and traumatic study group (45/50 [90%] vs. 139/241 [58%], p < 0.001). Accordingly, the number of patients being treated conservatively differed greatly (20/50 [40%] vs. 164/241 [56%]), with a worse clinical success rate for atraumatic lacerations (75% vs. 94.5%). Atraumatic splenic injuries showed a higher conversion rate to surgery (2/20 [10%] vs. 2/164 [1%]). Despite the lower clinical success rate of splenic artery embolization (SAE) in atraumatic injuries (87% vs. 97%), the number of patients needing treatment for primary SAE in AAST 3 injuries was 14.1 in the traumatic population and only 4 in the atraumatic population. Conclusions: Atraumatic splenic injuries should not be treated as traumatic splenic injuries. An early upgrade to SAE or surgery should be considered for moderate splenic injuries, and they should be evaluated by an interdisciplinary team on a case-by-case basis. However, due to the underlying multimorbidity of patients with atraumatic splenic injuries, a higher mortality is to be expected.

Microwave ablation after VATS in patients with multiple pulmonary nodules

BACKGROUND

The management of residual nodules after video-assisted thoracoscopic surgery (VATS) for multiple pulmonary nodules (MPNs) is challenging. Microwave ablation (MWA), which is highly repeatable and minimally invasive, has garnered widespread attention in the treatment of MPNs.

METHODS

Ninety-one patients with MPNs who underwent VATS for resection of high-risk nodules followed by MWA for residual nodules were examined. Clinical efficacy and complications were assessed. The primary end points were MWA success rate and complete ablation rate. Secondary end points were local progression-free survival (LPFS), overall survival (OS), and complications.

RESULTS

MWA was successfully completed in all patients. Mean tumor diameter, ablation time, and ablation output power were 0.81 cm, 3.4 minutes, and 39 W, respectively. LPFS was 100% at 3, 6, 12, and 24 months, respectively. OS was 100% at 12 and 24 months, respectively. No intraoperative or postoperative deaths occurred. Complications with MWA were infrequent. Pneumothorax was most common, occurring in 31 patients (34.07%); among these, seven (7.69%) required closed thoracic drainage. Pleural effusion occurred in six patients (6.59%), hydropneumothorax in five (5.49%), and pneumonia in three (3.30%). The pain level after MWA was moderate-to-severe in 29 patients (31.87%).

CONCLUSION

MWA is safe and feasible for treating residual nodules in patients with MPNs who have undergone VATS. The incidence of complications was low, and most complications were mild.