Safety and Effectiveness of Abre Self-Expanding Venous Stent for Treatment of Superior Vena Cava Syndrome

PURPOSE

Superior vena cava (SVC) syndrome is a constellation of symptoms that results from partial or complete SVC obstruction. Endovascular SVC stenting is an effective treatment for SVC syndrome with rapid clinical efficacy and low risk of complications. In this study, we assess the technical and clinical outcomes of a cohort of patients with SVC syndrome treated with the AbreTM self-expanding venous stent (Medtronic, Inc, Minneapolis, MN, USA).

METHODS

An institutional database was used to retrospectively identify patients with SVC syndrome treated with AbreTM venous self-expanding stent placement between 2021-2023. Patient demographic data, technical outcomes, treatment effectiveness, and adverse events were obtained from the electronic medical record. Nineteen patients (mean age 58.6) were included in the study. Thirteen interventions were performed for malignant compression of the SVC, 5 for central venous catheter-related SVC stenosis, and 1 for HD fistula-related SVC stenosis refractory to angioplasty.

RESULTS

Primary patency was achieved in 93% of patients (17/19). Two patients (7%) required re-intervention with thrombolysis and angioplasty within 30 days post-stenting. Mean duration of clinical and imaging follow-up were 228.7 ± 52.7 and 258.7 ± 62.1 days, respectively. All patients with clinical follow-up experienced significant improvement in clinical symptoms post-intervention. No stent related complications were identified post-intervention.

CONCLUSIONS

Treatment of SVC syndrome with the AbreTM self-expanding venous stent has high rates of technical and clinical success. No complications related to stent placement were identified in this study.

Awareness of interventional radiology and image guided musculoskeletal interventions among orthopaedic surgeons, rheumatologists, and physiatrists: A multi-site analysis

PURPOSE

Evaluate physicians who treat musculoskeletal (MSK) disorders in their knowledge of image-guided MSK interventions, and identify areas that could benefit from education.

MATERIALS AND METHODS

A 17-question survey was distributed to orthopaedic surgeons, physiatrists, and rheumatologists in the 14-hospital health system. It inquired about demographics, practice environment, awareness of interventional radiology (IR) and MSK radiology (MSKR) training, referral patterns, and knowledge of image-guided MSK interventions.

RESULTS

In total, 59 of 303 physicians completed the survey (41% orthopaedists, 35% physiatrists, and 24% rheumatologists). Most (93%) were attendings and 41% were female. A minority of survey respondents (17%) recognized the designation of IR as a distinct specialty of medicine per the American Board of Medical Specialties, in contrast to MSKR, which is not designated as a distinct specialty. When queried about IR procedures not under investigation, 24% selected genicular artery embolization and 31% selected embolization for adhesive capsulitis. Barriers to referral were as follows: 21% of specialists performed the procedure, 17% listed electronic medical record challenges, 14% reported scheduling difficulty, 13% reported no barriers, 11% reported difficulty consulting, 11% referred to another specialty, 10% did not have enough knowledge of image guided procedures, and 3% reported the procedure is not performed by IR or MSKR.

CONCLUSIONS

Survey data reveal a knowledge gap among surveyed physicians regarding IR as a specialty as well as areas of IR research in MSK disorders. Findings suggest areas where referring physicians can be educated and identify barriers to referral.

Genicular Artery Embolization as a Treatment for Osteoarthritis Related Knee Pain: A Systematic Review and Meta-analysis

OBJECTIVE

Genicular artery embolization (GAE) is a minimally invasive therapy for symptomatic osteoarthritis (OA) in patients with knee pain refractory to conservative management. The purpose of this study was to evaluate evidence on the effectiveness of GAE for OA related knee pain as part of a systematic review and meta-analysis.

MATERIALS AND METHODS

Using Embase, PubMed, and Web of Science, a systematic review was performed to identify studies evaluating treatment of knee OA with GAE. The primary outcome measure was change in pain scale score at 6 months. A Hedge's g was computed as a measure of effect size, selecting Visual Analog Scale (VAS) first if available and Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index if VAS was not available.

RESULTS

After screening titles, abstracts, and the full text, 10 studies met inclusion criteria. A total of 351 treated knees were included. Patients who underwent GAE demonstrated declines in VAS pain scores at 1 month {- 34 points [95% CI (- 43.8, - 24.6)], 3 months {- 30 points [95% CI (- 41.7, - 19.2)], 6 months {- 41 points [95% CI (- 54.0, - 27.2)], and 12 months {- 37 points [95% CI (- 55.0, - 18.1)]. Hedges' g from baseline to 1, 3, 6, and 12 months, was {- 1.3 [95% CI (- 1.6, - 0.97)]}, {- 1.2 [95% CI (- 1.54, - 0.84)]}, {- 1.4 [95% CI (- 2.1, - 0.8)]}, and {- 1.25 [95% CI (- 2.0, - 0.6)]}, respectively.

CONCLUSION

GAE provides durable reductions in pain scores for patients suffering with mild, moderate, and severe OA.

Modulating immunogenicity of factor IX by fusion to an immunoglobulin Fc domain: a study using a hemophilia B mouse model

Essentials Fc-fusion increases a therapeutic's half-life, but FcγR interactions may impact immunogenicity. Species-specific Fc-FcγR interactions allow for mechanistic in vivo studies using mouse models. Fc fusion modulates the immune response to factor IX in hemophilia B mice by eliciting Th1 bias. This model could inform future studies of IgE-associated anaphylaxis in hemophilia B patients.

SUMMARY

Background Fc fusion is a platform technology used to increase the circulating half-life of protein and peptide therapeutics. However, there are potential immunological consequences with this approach, such as changes in the molecule's immunogenicity as well as possible interactions with a repertoire of Fc receptors (FcR) that can modulate immune responses. Objectives/Methods Using a mouse hemophilia B (HB) model, we compared the immune responses to infusions of recombinant human factor IX (hFIX) and hFIX fused to mouse IgG2a-Fc (hFIX-mFc). The mFc was employed to allow species-specific Fc-FcγR interactions. Results Although treatment with hFIX-mFc altered the early development of anti-FIX IgG, no significant differences in anti-FIX antibody titers were observed at the end of the treatment regimen (5 weeks) or upon anamnestic response (5 months). However, treatment with hFIX-mFc elicited higher FIX-neutralizing antibody levels and resulted in reduced IgE titers compared with the hFIX-treated group. Additionally, differences in plasma cytokine levels and in vitro CD4+ T-cell responses suggest that whereas hFIX treatment triggered a Th2-biased immune response, hFIX-mFc treatment induced Th1-biased CD4+ T cells. We also show that hFIX-mFc bound to soluble FcγRs and engaged with FcγRs on different cell types, which may impact antigen presentation. Conclusions These studies provide a model system to study how Fc-fusion proteins may affect immune mechanisms. We used this model to demonstrate a plausible mechanism by which Fc fusion may modulate the IgE response to hFIX. This model may be appropriate for investigating the rare but severe IgE-mediated anaphylaxis reaction to hFIX infusions in HB patients.

Outpatient laparoscopic cholecystectomy. Outcomes of 847 planned procedures

BACKGROUND

Cholecystectomy is now being performed on an outpatient basis at many centers. The purpose of this study was to review the results of our large experience with this procedure.

METHODS

Between 1990 and 1997, 2288 patients underwent laparoscopic cholecystectomy at our clinic. A total of 847 (37%) were scheduled as outpatients. The selection criteria for planned outpatient laparoscopic cholecystectomy called for nonfrail patients with an ASA < 4 who were living < 2 h from the hospital. All patients received detailed preoperative instruction about outpatient laparoscopic cholecystectomy. A questionnaire was sent to 309 patients to sample their opinions.

RESULTS

Since 1993, we have increased the number of planned outpatient cholecystectomies performed at our clinic, but the percentage of cholecystectomies completed on an outpatient basis has remained approximately 60%. A total of 547 of 847 operations scheduled as outpatient procedures (74.5%) were completed as planned, and 204 patients (24%) were kept in the hospital overnight. Twenty-seven (3%) were converted to open procedures. Eighteen laparoscopic patients (2%) stayed > 1 day (range, 2-20). None of the patients died. Of the 142 patients (46%) who completed our opinion survey, 66% were happy with their experience, 32% would like to have stayed in the hospital, and 2% were undecided.

CONCLUSION

Successful same-day surgery requires proper patient instruction, appropriate patient selection, and a low threshold to convert patients to inpatient status when the situation warrants. No major complications occurred as a result of same-day discharge, and two-thirds of the patients said that they preferred outpatient surgery.