Journal of Interventional Medicine最新文献

Purpose

Compared with healthy individuals, patients with peripheral artery disease (PAD) generally have a very high risk of subclinical Coronary artery disease (CAD) and cardiovascular events. To determine the correlation between CAD in PAD patients, thereby promoting the lifetime of PAD patients and reducing the serious impacts of CAD.

Methods

This clinical-based cross-sectional study comprised 100 consecutive patients in India from 2014 to 2016. In this research, PAD patients were screened for CAD by treadmill stress test and cardiac colour Doppler examination. In addition, this study performed coronary angiography followed by peripheral angiography for patients who could not perform the treadmill test.

Results

With the statistical results, the study observed a high prevalence of CAD in PAD patients that can be detected only with angiography. Further, 30.93% of asymptomatic CAD prevalence was observed in PAD patients. The study strengthens the need for coronary angiography in all symptomatic lower limb PAD cases to detect early CAD, particularly in patients with diabetes and dyslipidemia.

Conclusion

There exists a strong correlation between PAD and CAD. Hence, precise diagnosis followed by supervision of PAD patients is significant for avoiding local progression of cardiovascular risk.

The increasing incidence of papillary thyroid microcarcinoma (PTMC) has become a global challenge. Because of its indolent nature, active surveillance (AS) has been proposed as a treatment option in selected PTMC patients to prevent surgery-related complications. However, only a few patients with PTMC receive the AS approach because of the serious psychological burden following the “cancer” diagnosis and the uncertainty of the timing for metastatic dissemination. Ultrasound (US)-guided thermal ablation can bridge the gap in the treatment options of PTMC patients who wish for a minimally invasive management approach. However, it has acquired only marginal attention from the thyroid guideline societies because of concerns regarding incomplete elimination. The recently published guidelines from the European Thyroid Association-Cardiovascular and Interventional Radiological Society of Europe and the American Head Neck Society Endocrine Section -initiated global consensus provide the most definitive evidence and essential foundational experience to address the long-term controversy over US-guided thermal ablation for low-risk PTMC patient management and facilitate the responsible global dissemination of minimally invasive strategies.

Purpose

Microwave ablation (MWA) is difficult to perform in colorectal liver metastases (CRLMs) adjacent to the cardiophrenic angle. Therefore, a modified approach involving antenna array placement parallel to the diaphragm was initially attempted. Its safety and efficacy were compared with those involving non-parallel placement.

Methods

Sixty-three patients with CRLMs adjacent to the cardiophrenic angle (lesions within 10 ​mm of the diaphragm) who underwent MWA were included in the study. All patients were further classified into parallel and non-parallel groups according to the method of antenna placement. The distance between the lesion and diaphragmatic surface before MWA, complications, and local tumor progression (LTP) at the last imaging follow-up were recorded. LTPs in the two groups were compared using the log-rank test. Prognostic factors for LTP were assessed using the Cox proportional hazards regression model.

Results

Thirty and 33 lesions were ablated using parallel and non-parallel antenna placement, respectively. During the mean follow-up duration of 19.7 ​± ​8.2 months, the LTP rate in the parallel and non-parallel placement groups were 3.3% (1/30) and 24.2% (8/33), respectively. The log-rank test showed that parallel antenna placement was associated with delayed LTP (p ​= ​0.018). Multivariate Cox regression analysis showed that parallel antenna placement was an independent predictor of delayed LTP after adjusting for possible risk factors, including age, sex, tumor size, and KRAS mutation (hazard ratio, 0.1; 95% confidence interval, 0.00, 0.80; p ​= ​0.034).

Conclusion

The placement of the antenna parallel to the diaphragm is an alternative and effective method for MWA of CRLMs near the cardiophrenic angle and can contribute to the reduction of the LTP rate.

Objective

To evaluate the efficacy and safety of percutaneous core needle biopsy (PCNB) using ultrasound (US)-guided and contrast-enhanced ultrasound (CEUS)-guided procedures for anterior mediastinal masses (AMMs).

Methods

In total, 284 consecutive patients (166 men, 118 women; mean age, 43.0 ​± ​18.4 years) who underwent PCNB for AMMs were enrolled. Patients were divided into the US-guided group (n ​= ​133) and the CEUS-guided group (n ​= ​151). PCNB was performed using a core needle (16-gauge or 18-gauge). Internal necrosis, diagnostic yield, and diagnostic accuracy were compared between the two groups.

Results

The predominant final diagnosis of the cases in this study was thymoma (29.7%), lymphoma (20.5%), thymic carcinoma (13.3%), and germ cell tumour (13.3%), respectively. There was no significant difference in patient age, sex, number of percutaneous biopsies, or display rate of internal necrosis on conventional US between the two groups. The rate of internal necrosis of the lesions was significantly higher after contrast agent injection (72.2% vs. 41.7%; P ​< ​0.001). The CEUS-guided group had a higher diagnostic yield than the US-guided group (100% vs. 89.5%, P ​< ​0.001). There was no significant difference between the diagnostic accuracy of the CEUS-guided and US-guided groups (97.3% vs. 97.4%; P ​= ​1.000). None of the patients experienced adverse reactions or complications after US-guided or CEUS-guided PCNB.

Conclusions

CEUS-guided PCNB can improve the diagnostic yield by optimizing the biopsy procedure.

Adenomyosis is a common gynecological disease in reproductive women, which causes serious dysmenorrhea, menorrhagia, anemia, and infertility, and has a serious impact on the physical and mental health of women. Considering that the efficacy of the traditional medication and surgical treatment is not ideal, an increasing number of patients are searching for more effective and less invasive therapies. Ultrasound (US)-guided microwave ablation (MWA) has emerged as a new effective and minimally invasive alternative treatment for symptomatic adenomyosis, and it is widely being used in clinical settings. Several studies have proven that it is an efficient and safe treatment modality for symptomatic adenomyosis, but a significant variance in clinical outcomes reported in previous studies was also observed. Herein, we have analyzed the potential causes of this problem from the aspects of the diagnosis of adenomyosis, symptom evaluation before ablation, steps of US-guided ablation treatment, and outcome evaluation after ablation. Simultaneously, the clinical problems existing in the ablation treatment of adenomyosis are discussed, and the directions of future research are pointed out.

Objective

To evaluate the efficacy and safety of uterine artery embolization (UAE) combined with dilation and curettage (D&C) using ultrasound as a treatment for cesarean scar pregnancy (CSP) and assess its effect on ovarian and reproductive function.

Methods

A total of 54 patients with uterine CSP between January 2011 and December 2015 were included in this retrospective study. The patients were treated with UAE combined with D&C using ultrasound for the treatment of CSP and followed up for 5–8 years. Their medical records, medical histories, clinical manifestations, treatment courses, and treatment results were analyzed.

Results

The 54 patients were initially treated without severe complications. β-Human chorionic gonadotropin (β-hCG) normalization took 36.11 ​± ​10.73 days (range, 25–84 days), length of hospitalization was 6.6 ​± ​1.5 days (range, 4–10 days), and total blood loss was 18.48 ​± ​8.41 ​mL (range, 5–33 ​mL). All patients resumed normal menstruation after 33.48 ​± ​8.71 days (range, 26–70 days). At the 5–8-year follow-up after UAE combined with D&C by ultrasound for the treatment of uterine CSP, the menstrual volume in 32 (59.3%) patients decreased versus before the operation. Compared with pretreatment, the menstrual cycle was prolonged in two (3.7%) cases, shortened in 10 (18.5%) cases, irregular in one (1.9%) case, and unchanged in 39 (72.2%) cases. Three patients conceived naturally and successfully gave birth to healthy children. Seven (12.96%) patients with accidental natural pregnancies chose induced abortion with no significant change in their sex lives.

Conclusion

UAE combined with D&C using ultrasound for the treatment of uterine CSP is safe and effective and may not affect the fertility of patients aged <40 years. However, menstrual volume may be reduced in some patients.

Objectives

To evaluate the safety and efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) using lauromacrogol sclerosant foam for gastric varices (GVs) with gastrorenal venous shunts.

Methods

Data of GV patients treated with BRTO using lauromacrogol sclerosant foam in 2016–2020 were retrospectively analyzed along with procedural success rate, complications, and follow-up efficacy.

Results

A total of 31 patients were treated with BRTO. The sclerosant foam was prepared by mixing iodinated oil, lauromacrogol, and air at a 1:2:3 ratio. The BRTO procedure was successfully completed in 93.5% of patients. One patient was allergic to the lauromacrogol injection. A mild postoperative fever occurred in three patients. One patient experienced grand mal seizures after the procedure. There was no significant difference in the median Child-Turcotte-Pugh scores before versus after BRTO. Complete GV resolution was observed in 93.1% of patients. One patient underwent endoscopic treatment for the development of high-risk esophageal varices. Another patient underwent transjugular intrahepatic portosystemic shunt placement for the aggravation of ascites.

Conclusions

Lauromacrogol sclerosant foam is safe and effective in patients undergoing BRTO for GV.

Prostate-targeted biopsy is usually the preferred method over systematic biopsy because it can effectively detect prostate cancer using only a few puncture cores with fewer complications. With the development of ultrasound, it has gained multimodal technological upgrades, such as the emergence of contrast-enhanced ultrasound, ultrasound elastography, and three-dimensional ultrasonography. Moreover, multimodal ultrasound has played an increasingly significant role in prostate-targeted biopsies.

Background

To establish a canine model of aortic arch aneurysm that is suitable for research on new devices and techniques applied to the aortic arch.

Materials and methods

Fifteen mongrel dogs underwent surgery. The autologous pericardial patch was sewn on the aortotomy site in the anterior wall of the aortic arch. The animals were followed up for 3 months postoperatively. Computed tomography angiography was used to visualize and measure the aneurysm model. Hematoxylin and eosin staining was used to observe the histological characteristics of the aneurysm model. Changes in aneurysm diameter over time were analyzed using analysis of variance.

Results

One dog died of hemorrhage during surgery. Fourteen dogs survived the surgical procedure. Two of them died on the first postoperative day because of ruptures at the suturing margin. The diameter of the aneurysm model was twice as large as that of the aortic arch. There was no significant change in the maximum diameter of the aneurysm model during the follow-up period.

Conclusions

We established a controllable and stable aortic arch aneurysm model created with an autologous pericardium patch. The aneurysm model can be used to research endoleaks after thoracic endovascular aortic repair and new endovascular techniques can be applied to the aortic arch.

Hepatic inflammatory pseudotumor (IPT) is a benign lesion characterized by chronic infiltration of inflammatory cells and fibrosis that clinically, radiologically, and pathologically mimics malignancy. However, the epidemiology of IPTs remains unclear. IPTs are often misdiagnosed as malignant lesions because of the lack of characteristic features. We present the case of a 32-year-old man that was misdiagnosed as intrahepatic cholangiocarcinoma by CECT, CEMRI, and CEUS, which was finally confirmed as IPT by fine-needle liver biopsy. In this report, the key factor in the diagnosis of liver inflammatory masses was the presence of hepatic perfusion disorder.