Journal of Vascular and Interventional Radiology最新文献

Occupational radiation exposure has a clear association with long-term health effects and has a particular impact on women, trainees, and supporting staff. There is a reliance on limited, traditional radiation protection and nonergonomic equipment, which carries associated orthopedic injury rates with adverse impacts on both individual career trajectories and health systems, and with significant challenges to widespread implementation of enhanced radiation protection devices. During the 2025 Society for Cardiovascular Angiography & Interventions Scientific Sessions in Washington, DC, a multidisciplinary Think Tank summit was convened and included representatives from multiple stakeholders, including other professional societies, advocacy groups, and industry partners. The focus of discussion was on the dual dangers of both ionizing radiation and the musculoskeletal injuries associated with current-generation protection equipment. This document summarizes the main points of discussion and outlines actionable next steps to advocate for more widespread implementation of enhanced radiation protection technologies and imaging systems in order to achieve ALARA+ (as low and as light as reasonably achievable).

Purpose: To evaluate the safety, effectiveness, and prognostic factors of large-bore mechanical thrombectomy (LBMT) for acute pulmonary embolism (PE) in an all-comer population of high- and intermediate-risk patients at a tertiary center.

Materials and methods: This retrospective study analyzed 52 consecutive patients [63.5% (33/52) male, mean age 62.6 ± 17.3 years] undergoing LBMT for acute PE from 2019 to 2024: 57.7% (30/52) high-risk and 42.3% (22/52) intermediate-risk per European Society of Cardiology (ESC) criteria with a Pulmonary Embolism Severity Index (PESI) score of 160.7 ± 51.7. Patients excluded from clinical trials-with malignancy [57.7% (30/52)], metastatic disease [13.5% (7/52)], and non-improvement despite systemic thrombolytics [19.2% (10/52)]-were included. Procedural outcomes, adverse events (AEs), and mortality predictors were examined.

Results: Median follow-up was 13.7 months [Interquartile range (IQR): 5.4-22.3)]. Mean pulmonary artery pressure decreased by 6.9 ± 6.4 mmHg. Refined modified Miller index (RMMI) reduced by 13.7 ± 5.9. Survival was 66.7% (20/30) for high-risk and 95.5% (21/22) for intermediate-risk at 6 months (p = 0.01). Society of Interventional Radiology (SIR) severe AEs occurred in 5.8% (3/52) of patients. Independent 6-month mortality predictors were metastatic disease [Odds ratio (OR) 42.5, 95% CI 3.28-258.81, p < 0.001], PESI score (OR 1.03 per point, 95% CI 1.00-1.06, p = 0.04), and ESC stratification (OR 0.08, 95% CI 0.003-0.48, p = 0.03).

Conclusion: In an unselected tertiary setting, LBMT demonstrates safety and effectiveness for acute PE with excellent survival of intermediate-risk patients and clinically meaningful outcomes for high-risk populations generally excluded from trials.

Clinical relevance statement: This study adds to the growing evidence (the FLAME study and the high-risk cohort of the FLASH study) to incorporate LBMT into the management pathways for patients with high-risk PE. Metastatic disease independently predicts increased mortality.

Purpose: To assess patency and characterize anatomical patterns of restenosis following percutaneous transluminal angioplasty (PTA) of cephalic arch stenosis (CAS) from patients with hemodialysis arteriovenous fistulas who were enrolled in the AVeNEW Trial¹.

Materials and methods: Among 280 patients enrolled in AVeNEW, patients with CAS randomized to PTA were identified. Clinical data and fistulograms were reviewed through 730 days. Kaplan-Meier curves were used to estimate target lesion primary patency (TLPP) and access circuit primary patency (ACPP). The cephalic vein arch was segmented into three regions: proximal, arch, and terminus. Recurrence patterns were characterized by comparing the site of index stenosis with the site of restenosis using Sankey diagrams.

Results: 70 patients with CAS were treated with PTA. Two ruptures and two unsuccessful PTAs yielded a modified intention to treat (m-ITT) group of 66 patients. TLPP and ACPP were equivalent at the 180, 365, and 730 day time points: 39.5%, 13.2%, and 5.6%, respectively. Regarding post-PTA restenosis, 15 patients were censored, leaving 51 patients for analysis. Terminus stenoses recurred at the terminus. Arch region stenoses often recurred in the arch region but 6/30 (20%) formed a new terminus stenosis.

Conclusion: PTA has a high technical successful rate for treating CAS, but TLPP and ACPP were poor; their equivalence indicates CAS drives circuit failure. Recurrence at the index site of stenosis was the most common, though PTA of stenosis in the arch region induced a new site of stenosis at the terminus region in some patients. Proximal stenoses exhibited variable recurrence patterns.

Purpose: To examine the cost implications of intravascular ultrasound (IVUS) in lower extremity deep venous intervention.

Materials and methods: This retrospective cohort study analyzed Medicare claims data from 2016-2021 for beneficiaries aged ≥ 65 years undergoing lower extremity venous interventions. Gamma regression adjusted for demographics and comorbidities assessed cost ratios for IVUS- vs. non-IVUS-guided procedures standardized to duration of follow-up. Rates of rehospitalization for causes attributable to complications of intervention were compared between IVUS and non-IVUS guided procedures by Cox regression. Results are shown as estimates with 95% confidence intervals.

Results: Among 52,610 patients, 42.6% underwent IVUS-guided procedures including stent placement, thrombolysis, or thrombectomy. IVUS use was highest in outpatient settings (75.3%) and ambulatory surgical center/outpatient-based laboratory (ASC/OBL; 86.4%), and lowest inpatient (10.4%). In all settings, IVUS use was associated with cost savings. In the inpatient setting, IVUS guidance was associated with a cost ratio of 0.91 (0.88-0.95) at 90 days, compared to 0.71 (0.6-0.73) in ASC/OBL and 0.73 (0.71-0.76) in hospital-based outpatient settings. Cost savings persisted at one- and three-year follow-up. IVUS guidance was associated with lower one-year complication-related hospitalization in outpatient procedures (HR = 0.73 [0.62-0.86]) and ASC/OBL procedures (HR = 0.78 [0.66-0.91]). Cost savings were present in stenting procedures at 90 days (cost ratio 0.71 [0.69-0.73]), whereas there was cost neutrality in thrombectomy (cost ratio 1.02 [0.97-1.08]) and thrombolysis (cost ratio 0.89 [0.75-1.05]).

Conclusions: IVUS-guided venous intervention was associated with durable cost savings and reductions in rehospitalization in all procedural settings among procedures involving stent deployment.

This retrospective observational study evaluated pre-extraction embolization on intraoperative blood loss (IBL) during tooth extraction in patients with jaw arteriovenous malformations (AVMs). Five patients (eight procedures) who underwent transcatheter arterial embolization (TAE), with or without direct puncture embolization (DPE). Technical success, IBL, clinical success-defined as absence of bleeding requiring transfusion during tooth extraction-and adverse events were assessed. TAE was performed in all procedures. DPE was additionally performed in five procedures when dilated venous cavities were present or postoperative bleeding persisted. The median IBL was 5 mL (mean ± SD, 408 ± 635 mL), with two procedures exceeding 1 L. Technical and clinical success rates were both 87.5%. One patient experienced a severe infectious adverse event requiring hospitalization after discharge. Pre-extraction embolization of jaw AVMs may help reduce bleeding, but severe hemorrhage can still occur. DPE may assist in rapid hemostasis, but clinicians need to remain prepared for life-threatening bleeding.

Purpose: To retrospectively compare the safety and feasibility of early and delayed feeding protocols after uncomplicated PFG placement.

Materials and methods: This retrospective, single-center study included 196 inpatients who underwent percutaneous image-guided balloon-retained gastrostomy tube placement between June 2020 and July 2024. The early feeding group (n=96) received enteral nutrition within 4.3 ± 2.3 hours following the procedure, while the delayed feeding group (n=100) initiated feeding at 28.6 ± 18.2 hours. Data was collected on patient demographics, adverse events, time of feeding initiation, and time to discharge.

Results: There was no statistically significant difference in adverse event rates between the early and delayed feeding groups (0% vs. 2%, P=0.498). No patients in the early feeding group exhibited signs of peritonitis, tube dislodgement, or hemorrhage. In the delayed feeding group, one patient experienced post-procedural hemorrhage requiring embolization and another developed post-procedural atrial fibrillation with rapid ventricular response requiring transfer to the intensive care unit. The mean time from gastrostomy tube placement to discharge was 10.0 ± 13.6 days in the early feeding group and 10.8 ± 12.0 days in the standard group (P = 0.413).

Conclusion: Early feeding following uncomplicated, balloon-retained percutaneous image-guided gastrostomy tube placement is safe and effective, with no increased risk of adverse events compared to delayed feeding. In addition, early feeding decreases fasting time which may mitigate cumulative nutrition deficit.

Purpose: To compare the in vitro effects of filters and ethiodized oil (EO) on the stability and component cost of sodium tetradecyl sulfate (STS) foam, emphasizing foam quality during a clinically relevant injection window.

Materials and methods: Eleven foaming methods using 2 mL of 3% STS and air were evaluated in nine replicates. Variables included stroke number (10, 20), air volume (2, 8 mL), filter pore size (0.2, 5 μm), and EO volume (0.2, 1.0 mL). Quarter-life (T¼), half-life (T½), and foamed volume at 120 s (FV120) were recorded. The primary endpoint was T¼ ≥ 30 s, defined as ≥75% of STS remaining in foam form within 30 s. Component cost and microscopic morphology were compared.

Results: All methods met the injection-window criterion. Control (STS:air 1:1) had the lowest stability (T¼ = 47 s; T½ = 73 s). The 0.2-μm filter improved stability (T¼ = 68 s; T½ = 104 s), whereas 1.0 mL EO extended T¼ and T½ beyond 120 s. T¼ gains were similar for the 0.2-μm filter and 0.2 mL EO, with filter cost <1% of EO. Air volume and stroke number had minimal impact.

Conclusion: EO and filters enhanced STS foam stability, with EO producing the strongest effect. All foaming methods met the benchmark delivery of ≥75% foamed STS within 30 s. Filters provide a practical option that may reduce cost and avoid unresolved questions regarding potential EO effects on STS bioactivity and in vivo phase separation.