Journal of Vascular and Interventional Radiology最新文献

This retrospective study was performed to determine the incidence, timing, and clinical manifestations of major hemorrhagic events following percutaneous solid organ biopsy procedures in 32,331 cases performed between 9/1/2005 and 8/9/2023. Bleeding was categorized using the Common Terminology Criteria for Adverse Events. Major hemorrhage occurred in 139 cases (0.4%) and was most common after splenic biopsy (7/197, 3.6%) and native kidney biopsy (49/5,699, 0.86%). Bleeding manifested within 1 hour in 60 cases (43%), between 1-2 hours in 15 cases (11%), between 2-24 hours in 46 cases (33%), and >24 hours in 18 cases (13%). Pain and hemodynamic instability were the most common manifestations, occurring in 96 (69%) and 63 (45%) patients, respectively. These findings confirm that the overall risk of major bleeding following solid organ biopsy is low, with splenic and renal biopsies entailing the highest risk. Delayed bleeding events are infrequent but should warrant consideration in guiding postprocedural follow-up.

Purpose: To evaluate the technical success, safety, and clinical effectiveness of vesical and/or internal iliac artery embolization in patients with intractable hematuria from bladder hemorrhage.

Materials and methods: A retrospective review of 36 patients (aged 49-89 years, mean 73.9 years) who underwent vesical and/or internal iliac artery embolization for non-traumatic intractable hematuria between January 2012 and July 2023 was performed. The most common etiologies for bleeding were pelvic tumors (n=20, 55.6%) and radiation cystitis (n=14, 38.9%). Prior to embolization, 24 patients (66.7%) had cystoscopic intervention. Most patients (n=29, 80.1%) were hemodynamically stable but 7 (19.4%) were in haemodynamic instability and nearly all (n=35, 97.2%) required blood transfusions.

Results: Technical success was 100%. Clinical success was achieved in 30 patients (83.3%) with 6 patients requiring further interventions. Bilateral superselective vesical artery embolization had a higher success rate (90%) compared to unilateral superselective embolization (70.6%). When bilateral embolization of vesical and/or internal iliac arteries was performed, clinical success occurred in 94.1% of patients, and when superselective vesical artery embolization was performed in conjunction with nonselective internal iliac embolization, clinical success reached 100%. No major adverse events or procedure related mortality were noted.

Conclusions: Superselective vesical artery embolization was effective in arresting intractable bladder hematuria, with clinical success further improved by internal iliac artery embolization and bilateral embolization.

Purpose: To measure the accuracy and cost of a proof-of-concept prompted large language model to route procedure requests to the appropriate phone number or pager at a single large academic hospital.

Methods: At a large academic hospital, existing teams, pager/phone numbers, and schedules were used to create text-based rules for procedure requests. A prompted LLM was created to route procedure requests at specific days and times to the appropriate teams. The prompted LLM was tested on 250 requests "in-scope" requests (explicitly defined by provided rules), and 25 "out-of-scope" requests using GPT-3.5-turbo and GPT-4 models from OpenAI and four open-weight models.

Results: The prompted LLM correctly routed 96.4% of in-scope and 76.0% of out-of-scope requests using GPT-4, which outperformed all other models (p < 0.001). All models demonstrated worse performance for requests during evening and weekend hours (p < 0.001) Open AI API costs were approximately $0.03 per request for GPT-4 and $0.0006 per request for GPT-3.5-turbo.

Discussion: This work demonstrates the accuracy of low-cost prompted LLMs to appropriately route procedure requests in a large academic hospital system. A similar approach may be used to help clinicians navigate a radiology phone tree, or as a tool to help reading room coordinators route requests effectively with decreased training.

Purpose: To quantify and characterize how advancing stages of Chronic Kidney Disease (CKD) affect the incidence of amputation & death among Peripheral Artery Disease (PAD) patients in the United States.

Materials and methods: The Premier Healthcare database was utilized, and included data from 8.5 million hospitalizations between 2016 and 2021. International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes were used to identify clinical conditions and co-morbidities.

Results: 874,788 patients with PAD were included, of which 106,956 (12.2%) had CKD. Among these patients, 6.2% had CKD Stage 1-2, 52.6% had CKD Stage 3-4, and 41.1% had CKD Stage 5. Amputation rates increased significantly with advancing stages of CKD (CKD 0: 7.8%, CKD 1-2: 20.1%, CKD 3-4: 19.5%, CKD 5: 31.3%, p<0.0001). In subgroup analyses, patients who had PAD, CKD 5, and Diabetes Mellitus (DM) had an amputation rate of 36.5%. The mortality rate among PAD patients increased significantly with advancing stages of CKD (CKD 0: 0.9%, CKD 1-2: 2.7%, CKD 3-4: 3.7%, CKD 5: 4.7%, p<0.0001).

Conclusion: PAD patients with CKD 5 had 4 times higher amputation rates (31.3% vs 7.8%) and 5 times higher mortality (4.7% vs 0.9%) compared to PAD patients without CKD. Patients with PAD, CKD 5, & DM had the highest amputation rate among the groups studied (36.5%).

Purpose: To assess the safety and effectiveness of transcatheter embolization for treatment of pulmonary arteriovenous malformations (PAVM) and the clinical outcomes of patients after this procedure.

Materials and methods: PubMed, Cochrane Library, and Embase databases were searched for studies on PAVM embolization published from January 2003 to December 2023 without language restrictions. Clinical studies with a sample size of five or more patients and ten or more PAVMs were included. Technical success, persistence, and adverse events were recorded. Embolization techniques were compared based on comparative studies.

Results: A total of 54 studies were included in this meta-analysis. Based on available data, technical successful malformation occlusion was achieved in 98.3% by end of embolization procedure (95%CI: 95.1-100.0%) among 1468 patients. The pooled persistence rate during follow-up was 13.2% (95%CI: 9.8-16.7%) based on 2946 patients. Using plugs was associated with a lower persistence rate than coils-only (13.6% versus 32.7%, OR: 2.07, 95%CI: 1.04-4.13, p=0.039). Venous sac embolization was associated with a lower persistence rate compared to feeder artery embolization (3.5% versus 24.3%, OR: 5.34, 95%CI: 2.32-12.27, p<0.001). The pooled overall severe adverse event rate was 0.9% (95%CI: 0.4-1.3%). The pooled rate for post-embolization catastrophic event was 1.3 % (95%CI: 0.3-2.2%).

Conclusion: PAVM embolization has a favorable technical and treatment success rate and low risk of severe adverse events. Vascular plugs and venous sac coil embolization were associated with lower persistence. Current literature remains heterogenous with limited correlation analysis between persistence and catastrophic events. Future higher quality studies with longer clinical follow-up are warranted.