Journal of Vascular and Interventional Radiology最新文献

Purpose: To evaluate oncological outcomes, abscopal effect, and adverse events of pulsed electrical field (PEF) ablation of tumors in the chest, abdomen, and pelvis.

Materials & methods: PEF ablations performed at an academic medical center between May 2023 - January 2024 were retrospectively analyzed . 11 patients (male/female: 4/7, age:58 ± 19) underwent 11 PEF sessions targeting 13 tumors (lung metastasis from solitary fibrous tumor (n=3) and colorectal carcinoma(CA) (n=1), osteosarcoma pleural metastases (n=2), hepatocellular CA (n=2),liver metastasis from colorectal CA (n=1)and leiomyosarcoma (n=1), metastatic melanoma to pancreas (n=1), metastatic retroperitoneal lymph node from endometrial CA(n=1), recurrence of endometrial CA in vaginal cuff(n=1)) with the goal of complete coverage (n=11/13) or debulking (n=2/13). The mean tumor diameter was 1.9 ± 1.0 cm (range, 0.4 - 3.3 cm). Cross-sectional imaging follow-up was 5.3 ± 2.2 months (range, 1.9 - 7.9 months). Oncological outcomes, abscopal effect, and adverse events categorized according to SIR guidelines were reported.

Results: Of 11 tumors underwent ablation for complete coverage, complete coverage was achieved for 1 (9%) and residual detected in 9 (81%). 10 of 11 patients (91%) showed either residual, local or distant progression within a median of 3 months. No abscopal effect was observed. There were 2 mild and 2 severe adverse events.

Conclusions: PEF ablation showed a low rate of complete coverage (9%) and a high rate (91%) of residual, local or distant progression. No abscopal effect was observed within a median of 5.1 months after the ablation.

Purpose: This systematic review aimed to compare covered stent (CS) and bare metal stent (BMS) in treating aortoiliac occlusive disease (AIOD).

Methods: Comprehensive searches were conducted in the Medline, Embase, and Cochrane Library databases for all pertinent studies. The end points included primary patency, secondary patency, freedom from target lesion revascularization (TLR), technical success, ankle-brachial index (ABI) improvement, perioperative complications, major amputation and mortality. Odds ratios (OR) or risk differences (RD) with 95% confidence intervals (CI) were used to estimate the binary variables. The continuous variables were presented as mean difference (MD) with 95% CI.

Results: Ten studies involving 1861 limbs were included. For overall outcomes, compared to BMS, CS showed significantly superior in freedom from target lesion revascularization (TLR) (OR=3.00, 95% CI: 1.05-8.51, p=0.04) and ankle-brachial index (ABI) (MD=0.03, 95% CI: -0.00-0.06, p=0.04). No significant differences were found in technical success, primary patency (at 12, 24, 36, and 60 months), secondary patency, perioperative adverse events, major amputation rates and early mortality. Subgroup analyses favored CS in ABI improvement (MD=0.06, 95% CI: 0.02-0.11, p=0.01) after propensity score matching (PSM), and covered balloon expandable stents (BES) demonstrated certain advantages in freedom from TLR (OR=4.60, 95% CI: 1.79-11.81, p=0.002). Additionally, no significant difference in primary patency at 36 months between the two groups with TASC D or severe calcification lesions.

Conclusions: Compared to BMS, CS presented advantages in reducing TLR and enhancing ABI improvement. Meanwhile, CS demonstrated comparable technical success, primary patency, secondary patency, perioperative complications, major amputation rates and early mortality.

Purpose: To investigate the effect of transcatheter arterial embolization (TAE) on the 30-day survival of patients with isolated pelvic fractures, focusing on the influence of shock status and age.

Materials and methods: This retrospective cohort study used data from the Japan Trauma Data Bank (2004-2018). Patients with isolated pelvic fractures, defined by an Abbreviated Injury Scale score of ≥3, were included. Shock (shock index ≥1) and non-shock (shock index <1) were grouped. Inverse probability weighting using propensity scores was performed to adjust for the confounding factors. The primary outcome measure was the 30-day in-hospital mortality. The 30-day survival was compared by age groups: 0-19 years, 20-39 years, 40-59 years, 60-79 years and ≥80 years.

Results: Of the 5,025 eligible patients, 866 presented with shock, and 4,159 served as the non-shock group. The propensity score analysis showed that there was no significant difference in survival between the TAE and non-TAE groups in patients without shock (TAE group: 92.4% vs. non-TAE group: 92.5%; risk difference -0.05%, 95% confidence interval [CI]: -0.5% to 0.4%). Conversely, for patients with shock, the TAE group had a significantly higher 30-day survival rate than the non-TAE group (83.0% vs. 76.2%; risk difference 6.7%, 95% CI: 5.1% to 8.3%). Among the age groups, the risk difference was highest in the ≥80 years age group (78.5% vs. 66.6%, risk difference 11.9%, 95% CI: 7.7% to 16.1%).

Conclusion: This nationwide study suggested that provision of TAE is associated with improved 30-day survival in patients with isolated pelvic fractures and shock, particularly for those aged ≥80 years.

The Society of Interventional Radiology Foundation (SIR Foundation) aims to promote scientific research in Interventional Radiology by providing funding to promising investigators. Over the last 26 years, the SIRF has awarded more than 280 research grants. In 2020, the SIRF created a SIRF/NIH task force to evaluate the scientific ramifications of these funds in terms of overall productivity and research impact. The objective of this study was to evaluate the publication output and overall research impact of SIRF grantees from 1996 - 2022. During this time, the SIRF awarded 282 total research grants, which amounted to $5,907,380 in total funding, leading to 140 publications. Of these 140 publications, 67 were published in journals outside of JVIR and cited 1753 times. The median impact factor of journals outside of JVIR was 4.98 (range: 0.33 to 18.8). The remaining 73 publications were published in JVIR, with a peak impact factor of 3.7, leading to 1687 citations. There were 3440 citations, and the conversion rate of grants (282) to publications (140) was 48%. The median relative citation ratio was 0.68 (range: 0 to 19.42). ANOVA testing per grant mechanism demonstrated a statistically significant correlation (p<0.001) between a particular grant mechanism and the number of publications. Furthermore, linear regression demonstrated a significant increase in the mean impact factor of publications with respect to time, with more recent publications published in higher-impact journals.

Purpose: To determine effectiveness of radiofrequency ablation for treatment of intrahepatic cholangiocarcinoma (iCCA) using a population-based database.

Materials and methods: Data was extracted from Surveillance, Epidemiology, and End Results database from 2000 to 2020 to include 194 patients who underwent ablation for iCCA. Patient demographics, overall survival (OS), and cancer-specific survival (CSS) were retrieved. Factors associated with survival were evaluated. Comparison between ablation and surgical resection (n=2653) or external beam radiotherapy (n=1068) were performed.

Results: In the ablation group, atients diagnosed and treated after 2010 demonstrated improved OS than the 2000-2009 subgroup (mOS 32 versus 21 months, HR: 0.50 [95%CI: 0.33-0.75], p=0.001). Additional factors associated with OS included tumor size (≤3cm versus >3cm, p=0.049) and tumor stage (p<0.001). For patients diagnosed after 2010, the 1-, 3-, and 5-year OS were 82.8% (95%CI: 74.8-88.4%), 43.5% (95%CI: 33.5-53.1%), and 23.7% (95%CI: 15.3-33.5%), respectively. Patients with local disease (1-year OS: 87.8% [95%CI: 78.6-93.3%]) demonstrated improved OS than regional (1-year OS: 81.3% [95%CI: 52.5-93.5%]) and distant disease (50.2% [95%CI: 34.0-78.8%], p<0.001). For tumors ≤3cm, ablation and surgical resection offered comparable survival benefits (p=0.561), although both were better than radiotherapy (p<0.0001).

Conclusion: Survival of iCCA patients who underwent thermal ablation has improved over the last 10 years. For tumors ≤3cm, ablation could be as effective as resection with careful candidate selection, and may be considered as front line compared to radiotherapy in certain patient populations. Patient selection based on tumor size and disease stage could improve survival outcomes.

Objective: To compare the incidence of in-stent restenosis (ISR) and ipsilateral neurological symptoms in patients treated with maximum plaque dilation before stent deployment (max-pre-D) and stent placement followed by angioplasty (post-D) technical variants of carotid artery stenting (CAS) at mid-term follow-up.

Methods: Single-center, real-world, retrospective comparative study of 307 patients treated in a single Vascular Surgery Unit between 2014 and 2018. The follow-up protocol consisted of duplex ultrasound performed at 1-, 6-, 12-months and annually thereafter. The primary outcome was to compare the incidence of ISR ≥ 70% in patients treated with post-D and max-pre-D. Secondary outcomes included between-group comparison of: i) symptomatic ISR, ii) reinterventions and iii) ipsilateral neurological events.

Results: 270 patients (121 max-pre-D, 149 post-D) fulfilling the inclusion criteria were included in the statistical analysis. Mean follow-up was 30.5 months (SD 25.6). The ISR rate was 4.1% (n=5) in max-pre-D group and 2.7% (n=4) in post-D group, with no significant difference in the survival analysis (log-rank p=0.664). Symptomatic ISR and retreatment occurred in three patients (33.3% of the total ISR for each outcome). Twenty-one ipsilateral neurological events occurred, 7 in the max-pre-D group (5.8%) and 14 in the post-D group (9.9%), with no statistically significant difference in survival analysis (log-rank p=0.315).

Conclusion: ISR and major neurological events did not differ significantly between the max-pre-D and post-D groups. Max-pre-D seems to be as effective as post-D technique in mid-term follow-up.

Purpose: To elucidate the characteristics of imipenem/cilastatin (IPM/CS) as an embolic material in microvessels in vivo.

Materials and methods: Three healthy rabbits were injected subcutaneously in one auricle with picibanil in advance to create an inflammation-induced neovascular model. Microangiography was performed using monochromatic X-rays obtained from a large synchrotron radiation facility (super photon ring-8; SPring-8). All rabbits underwent pre-embolization microangiography under anesthesia. Embolization from the central branch of the auricular artery was then performed using a mixture of IPM/CS (0.2 g) + non-ionic contrast medium (2 ml). Microangiography was performed immediately after and at 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after embolization. The diameter of embolized vessels was measured from the images immediately after embolization. Recanalization times were evaluated from the post-embolization to 90 minutes after embolization, and they were compared between normal sites and sites where inflammation was induced.

Results: The mean diameter of the embolized vessels immediately after embolization evaluated at the normal site was 267 ± 58.35 (range: 174-363) μm. Evaluation of post-embolization recanalization showed that vessels in the normal sites recanalized after a mean of 70 (range 50-70) min, whereas vessels at the sites of inflammation did not recanalize in observations up to 90 minutes after embolization.

Conclusions: This study characterized IPM/CS as an in vivo embolic substance and the duration of the embolic effect differed between normal and inflamed sites.

Clinical relevance/application: IPM/CS exhibited an ultra-short embolic effect not seen with existing embolic materials and may have a long embolic effect specific to inflamed vessels rather than normal vesseles. This characteristic could contribute to the indications for embolization being expanded to new diseases, such as embolization for pain relief in chronic joint pain.