Journal of Vascular and Interventional Radiology最新文献

Transcatheter retrograde testicular vein embolisation for symptomatic varicoceles is well-established but has a documented failure rate. Percutaneous anterograde varicocele embolisation may be a suitable alternative. A retrospective observational, descriptive study of consecutive patients who underwent percutaneous anterograde varicocele embolisation at a single centre was performed. Twenty patients (16 adults, 4 adolescents) underwent unilateral varicocele treatment. Technical success rate was 100%. Mean (SD) fluoroscopy time was 106.5 (24.9) seconds. For patients treated for subfertility, mean (SD) DNA fragmentation index significantly decreased from 29.4 (4.48)% to 22 (2.45)% pre and post procedure. No clinical or radiological evidence of varicocele recurrence was detected at 1- and 2- year follow-up. Four patients (20%) experienced self-limiting pain. No major adverse events occurred. Percutaneous anterograde varicocele embolisation appears to be safe with high technical and clinical success rate. Larger studies are required to further evaluate this. Radiation dose may be lower than with retrograde embolisation.

This study aims to test the hypothesis that Pressure Enabled Drug Delivery (PEDD) with a TriNav device would increase delivery of Embospheres via hepatic artery infusion to liver tumors in an oncopig model when compared to a conventional endhole microcatheter. Embospheres (100-300um in size) were fluorescently labeled and infused into porcine liver tumors using conventional technique (n=8) or by PEDD (n=8). Liver tissue was harvested and we analyzed images with a custom Visiopharm Deep Learning algorithm (Visiopharm A/S) to quantitate signal intensity. PEDD increased Embosphere penetration into the tumor by 227% (p = 0.029) when compared to conventional methodology and improved T/N ratio from 2.7 to 4.2. These data demonstrate improved delivery into tumor tissue using PEDD, along with improved selectivity by minimizing relative off-target deposition.

Hepatocellular carcinoma (HCC) is a leading and increasing contributor to cancer-related death worldwide. Recent advancements in both liver-directed therapies in the form of Y-90 radioembolization (Y-90-RE) and systemic therapy in the form of immune checkpoint inhibitors (ICI) have expanded treatment options for patients with an otherwise poor prognosis. Despite these gains, ICIs and Y-90-RE each have key limitations with low objective response rates and persistent hazard of out-of-field recurrence, respectively, and overall survival remains low. However, each therapy's strength can mitigate the other's weakness, making them ideal partners for combination treatment strategies. This review discusses the scientific and clinical rationale for combining Y-90-RE with ICIs, highlights early clinical trial data on its safety and efficacy, and proposes key issues to be addressed in this emerging field. With optimal strategies, combination therapies can potentially result in durable and curative outcomes in later stage patients rarely achieved just a decade ago.

Purpose: To determine the extent that social determinants of health have on uterine artery embolization (UAE) utilization for treatment of symptomatic uterine fibroids.

Methods: In this IRB-exempt study, data from the 2011-2020 National Inpatient Sample was used to identify patients with ICD-9 and -10 codes of uterine fibroids who underwent UAE. Data collected included: patient's demographics (race/ethnicity, income, insurance status) and procedure location (geographic region, hospital setting). Results are presented in percentage (UAE procedures per variable) and analyzed using Chi-square test.

Results: UAE utilization by race/ethnicity demonstrated the following distribution: Non-Hispanic Blacks (45.6%), Non-Hispanic Whites (28.1%), Hispanics (14.2%) and Asians (5.7%). The lowest quartile for income experienced no change in utilization (27.8%), while the highest quartile gradually decreased across the decade (2011:26.7%, 2020:19.0%, p=0.01). The Northeast region of the US (49.0% in 2011) was superseded by the South (34.8% in 2020) as the dominant geographic region for UAE. The main insurance statuses were private (55.5%) and Medicaid (26.2%), with Medicaid rates increasing throughout the decade (2011:18.2%, 2020: 28.6%, p < 0.001). Urban teaching hospitals accounted for the highest rates of total UAE (82.3%), compared to urban non-teaching (16.0%) and rural hospitals (1.2%).

Conclusion: Over the past decade, UAE has been performed in a relatively equitable fashion on the basis income, with improved utilization within the Medicaid population and throughout the geographic regions of the US. When accounting for US population representation and unequal disease burden, Non-Hispanic Blacks demonstrated a greater-than-expected utilization of UAE, compared to lower-than-expected rates among Non-Hispanic Whites.

Purpose: To evaluate the outcomes of early primary stent placement (within 30 days of liver transplantation) for hepatic artery stenosis (HAS).

Methods: Patients who underwent liver transplantation between 02/2001 and 02/2024 were evaluated for hepatic artery stenosis. Patients who underwent primary stent placement were selected and stratified based on the time from anastomosis to intervention. Early intervention were defined as primary stent placement within 30 days of surgical anastomosis. Kaplan-Meyer analysis was performed for primary patency.

Results: HAS occurred in 83/779 (11%) patients (Median Age 55 (Interquartile Range: 48 - 63), 27 (48%) females) with 56 patients meeting inclusion criteria. Stent placement performed within 0-6 days of the anastomosis in 11 (20%), 7-14 days in 11 (20%), 15-30 days in 7 (12%), 31-70 days in 9 (16%) and >70 days in 18 (32%) patients. Technical success was 100%. Primary patency rates were 89%, 87%, and 87% at 1, 3, and 5 years, respectively. Primary assisted patency rates were 100% at 1, 3, and 5 years. Early interventions at 0-6 days, 7-14 days, and 15-30 days showed primary patency rates of 100%, 90%, and 86% respectively at 1 year (p = 0.58). There was no difference in primary patency between the early (<30d) and late (>30d) cohorts (p = 0.88). There was 1 Grade 4 adverse event. There were no cases of anastomotic rupture, hepatic artery dissection, or graft failure.

Conclusion: Hepatic artery stent placement within 30 days of liver transplantation is safe and technically successful with excellent long-term primary patency.