Journal of Vascular and Interventional Radiology最新文献

Purpose: To evaluate the safety and degree of pain relief of three rapidly biodegraded embolic materials, including imipenem/cilastatin (IPM/CS), quick-soluble gelatin sponge particles (QS-GSPs), and resorbable microsphere (RMs), in transcatheter arterial embolization (TAE) for degenerative, inflammatory, and overuse joint disorders.

Materials and methods: Consecutive 431 patients, 527 joints with refractory overuse injuries, knee osteoarthritis, frozen shoulder, symptomatic rotator cuff tear, synovitis of the foot joints, and persistent pain after knee joint arthroplasty who underwent TAE between March 2020 and May 2023 were included in this retrospective study. IPM/CS, QS-GSPs, and RMs were used in 140 patients (176 TAEs), 136 patients (163 TAEs), and 155 patients (182 TAEs), respectively. Adverse events were monitored immediately after the procedure. Changes in pain numeric rating scale (NRS) were evaluated at 1, 3, and 6 months after TAE.

Results: No serious adverse events were observed. Increased pain at the site of embolization after the procedure lasting more than 7 days occurred in 7.1%, 22%, and 5.8% of patients with IPM/CS, QS-GSPs, and RMs, respectively, more commonly in the elbow joint. The NRS improved from the baseline to 1, 3, and 6 months in IPM/CS patients (6.9±1.3 vs. 4.4±2.2, 3.6±2.3, and 3.1±2.4, respectively, all p <.0001), QS-GSPs patients (6.4±1.5 vs. 4.3±2.1, 3.6±2.2, and 3.0±2.1, respectively, all p <.0001), and RMs patients (7.0±1.3 vs. 4.4±2.2, 3.2±2.1, and 2.3±1.8, respectively, all p <.0001).

Conclusions: IPM/CS, QS-GSPs, and RMs demonstrated acceptable safety profiles and effectively alleviated symptoms in TAE for degenerative, inflammatory, and overuse joint disorders.

Purpose: To compare patient characteristics, regional utilization, and post-operative outcomes between uterine artery embolization (UAE), myomectomy and hysterectomy for fibroids and adenomyosis, and assess whether post-operative adverse events were more common after hysterectomy.

Materials and methods: This observational study identified all women who underwent UAE, myomectomy or hysterectomy for fibroids or adenomyosis from 2016-2019 in the US, using TriNetX, a multi-institution database of anonymous health records, yielding 78,758 patients, (UAE: 2,505; hysterectomy: 60,333; myomectomy: 15,920). Regional procedure utilization was assessed. Length of stay (LOS), re-intervention, and post-procedure adverse events including pelvic floor prolapse and intestinal obstruction were compared. Pregnancy and miscarriage rates after UAE and myomectomy were assessed.

Results: Compared to UAE, hysterectomy was associated with longer LOS (5 v. 1 day, P<0.01), more blood transfusions (1.8 v. 0.7%, P<0.01), increased pelvic floor prolapse (7.1 v. 1.7%, P<0.01) and intestinal obstruction (3.4 v. 1.2%, P<0.01), and decreased reintervention (0 v. 15.5%, P<0.01) within 5 years; myomectomy was associated with more blood transfusions (2.0 v. 0.7%, P<0.01), fewer emergency room visits within 1 month (2.9 v. 6.8%, P=0.01), and similar re-intervention rates (17.0 v. 15.5%; P=0.06). Pregnancy occurred in 92/2,505 (3.6%) UAE and 2,744/15,920 (17.2%) myomectomy patients, with 18% and 11% miscarriage rates, respectively (P=0.07). UAE utilization was similar across US regions.

Conclusion: Despite increased adverse events including intestinal obstruction and pelvic floor prolapse, hysterectomy was the most common intervention in women with uterine fibroids and adenomyosis. Reintervention occurred after in 15-20% of patients after UAE or myomectomy.

This study reviews 657 transvenous liver biopsies using a transfemoral transcaval (TFTC) approach performed at a single institution between February 2014 and February 2024, highlighting three severe adverse events (AE). The retrospective review was performed for all TFTC liver biopsies. Technical success was attained in 99.4% of cases (n=653), and histopathological success in 97.1% of cases (n=638). Twenty-three mild (3.5%), one moderate (<1%), and eight severe (1.2%) AEs were reported. Three severe AEs were directly biopsy-related: a gastrointestinal bleed, a gallbladder fossa hemorrhage, and an extrahepatic bile duct leak. Review of the imaging suggests that these biopsies were taken at a point inferior to the intrahepatic inferior vena cava (IVC) which may have led to extrahepatic puncture. The TFTC approach demonstrates a favorable safety and efficacy profile. Importantly, careful attention must be paid to avoid low punctures inferior to the intrahepatic IVC, as they may be associated with AEs.

In the ATTRACT trial, 691 patients were randomized to receive, or not receive, pharmacomechanical catheter-directed thrombolysis (PCDT) to treat acute proximal deep vein thrombosis (DVT). Serious adverse events and suspected PE (collectively, "late symptom events", LSEs) were reported. An independent physician, blinded to treatment allocation, categorized LSEs occurring 1-24 months post-randomization by whether they could relate to post-PE syndrome. PE-related LSEs were frequent (66.7%) in patients who presented with diagnosed or suspected PE and infrequent (2.0%) in others, but PCDT did not influence their occurrence (PCDT 11.0% vs. No-PCDT 11.0%, p=1.000). However, in the iliofemoral DVT subgroup, PCDT Arm patients had fewer PE-related LSEs per patient (PCDT 0.14 vs. No-PCDT 0.24, p=0.036) and fewer PE-related breathing/lung LSEs per patient (PCDT 0.08 vs. No-PCDT 0.16, p=0.023). These findings suggest that assessment for post-PE syndrome after DVT thrombolysis can be focused on studies of iliofemoral DVT patients with PE symptoms at baseline.

Purpose: To prospectively evaluate the safety and efficacy of gallbladder cryoablation in patients with calculous cholecystitis initially treated with percutaneous drainage.

Materials and methods: High-operative risk patients with calculous cholecystitis treated with cholecystostomy tube drainage underwent gallbladder cryoablation. The primary end points were safety, defined as the absence of procedure related adverse events during the follow-up period, and clinical success, defined as the absence of symptoms after cholecystostomy tube removal. The secondary end point was imaging success, defined as gallbladder involution on CT or MRI.

Results: Ten patients underwent gallbladder cryoablation. Mean age was 71+/-10 years (range 53 to 90). Mean ASA score was 3+/-1 (range 2 to 4) and mean modified Frailty Index was 4+/-2 (range 1 to 6). Cholecystostomy tubes were in situ for a mean of 60+/-26 days (range 18 to 94) prior to cryoablation. Mean duration of clinical follow-up was 563+/-152 days (range 326 to 799) and imaging follow-up was 368+/-235 days (range 66 to 792). One infection and one mortality occurred, both in patients with gallstones >20 mm in size, prior pseudomonas infection, and iceball volumes >150 cm³. IRB review concluded that the cause of the mortality was a medication allergy. Clinical and imaging success was achieved in 9 of 10 patients.

Conclusion: Gallbladder cryoablation may be an effective treatment for high-operative risk patients with calculous cholecystitis initially treated with percutaneous drainage, with 90% clinical and imaging success. Optimization of patient selection is indicated, with particular reference to gallstone size and bacterial colonization.

Purpose: To evaluate postpartum hemorrhage (PPH) and Interventional Radiology (IR) service landscapes in Kenya using geospatial analytic mapping for outreach planning.

Materials and methods: Geographic information system (GIS) analysis of Kenya was performed using open-source data sets. Data at the regional and county levels from 2014-2018 were collected to evaluate demographics and variables related to PPH and healthcare access. Population risk indices were created based on these data. Detailed multi-layered GIS mapping was performed to produce visual data representations of the findings for outreach planning.

Results: From 2014 to 2018, the incidence of maternal hemorrhage in Kenya increased by 38%. Six hospitals in Kenya offer the IR services required to treat PPH, all located in Nairobi. Relative to other counties, maternal mortality ratios (MMRs) in Nairobi were near the median, falling within standard deviations of -0.5 to 0.5. MMRs were highest in the southeastern and northwestern regions of the country, with standard deviation increases of 1.5-2.3 and 0.5-1.5 respectively. Risk index and population maps identified high-impact hospitals for IR outreach.

Conclusion: GIS analysis demonstrated disproportionate rates of maternal morbidity and mortality due to PPH in areas without IR capabilities. It proved to be a valuable tool to understand population health and can be leveraged to strategically target global IR services.