Journal of Vascular and Interventional Radiology最新文献

Purpose: To evaluate the safety of including bowel in the ice-ball during cryoablation.

Materials and methods: 43 patients who underwent 50 cryoablations between 1/1/2012 and 2/1/2023 were retrospectively reviewed and compared to a control cohort of those undergoing cryoablation without bowel involvement (n=86). Adverse events (AEs) were stratified by the Society of Interventional Radiology Adverse Events classification system, 2017 (1). Adverse events occurring within 12 months and factors that may affect the AE rate, such as degree of bowel involvement and portion of bowel involved, were reviewed.

Results: Fourteen AEs occurred in 13 patients (13/43, 30.2%). This included 7 grade 1 AEs (7/43,16.3%), 3 grade 2 (3/43,7.0%) and 4 grade 3 (4/43,9.3%). Of them 1 grade 3 AE was judged to be related to bowel involvement (1/43,2.3%). When comparing AEs by degree of bowel wall involvement, there were more injuries with the full thickness bowel wall cases (6/9,66.7%), compared with partial thickness, but the findings were not statistically significant (p=0.140). When looking at AEs by portion of the intestine involved, it was found that 7 (7/14,50%), 10 (10/17,58.8%), and 4 (4/19, 21.1%,p=0.055) were found when stomach, small bowel or large bowel was involved respectively. No significant difference in AEs (13/43,30.2% vs 31/86,36%,p=0.511) or severe AEs (4/43, 9.3% vs 9/86, 10.5%, p=0.836) was found between the study and control cohorts.

Conclusion: Findings from this single center retrospective experience suggest that bowel wall involvement by the ice ball during cryoablation resulted in a lower-than-expected rate of adverse events for bowel-related injuries.

Objective: To assess the efficacy and safety of drug-eluting embolic bronchial arterial chemoembolization (DEE-BACE) in lung cancer, and to compare its outcomes with those of conventional bronchial arterial chemoembolization (cBACE).

Materials and methods: A comprehensive search was conducted across PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases. Random-effects model analysis was applied when I² was ≥ 50%; otherwise, fixed-effects model analysis was used. Subgroup analysis was performed for I² values ≥ 50%. Eighteen studies involving 681 patients were included, with 501 patients receiving DEE-BACE and 110 patients undergoing cBACE.

Results: Among lung cancer patients treated with DEE-BACE, the pooled objective response rates (ORRs) at 1, and 6 months were 64.4%, and 50.3%, respectively; the disease control rates (DCRs) were 93.4%, 74.4%, and 71.7%, respectively. The 1-year overall survival (OS) and progression-free survival (PFS) rate were 48.2%, and 22.5%, respectively. The incidence of adverse events was less than 50%. Compared with the cBACE group, the DEE-BACE group exhibited higher 1-month DCR [pooled relative risk (RR): 1.236, 95% confidence interval (CI): 1.028, 1.486), 6-month (pooled RR: 2.036, 95%CI: 1.226, 3.383) ORR and DCR (pooled RR: 1.824, 95%CI 1.249, 2.662). Both DEE-BACE and cBACE exhibited similar rates of adverse events.

Conclusion: DEE-BACE presents a favorable efficacy and safety profile for lung cancer treatment compared with cBACE, particularly for nonresectable cases or when chemotherapy or radiation therapy options are limited. However, the lack of direct comparisons to standard treatments require cautious interpretation of these results.

Purpose: To evaluate the outcomes of resin-based yttrium-90 radioembolization (TARE) for hepatocellular carcinoma (HCC) as a bridging or downstaging therapy to liver transplantation (LT) in terms of safety, tumor response, recurrence, and survival.

Materials & methods: A single-center retrospective analysis of patients with HCC treated with resin-based TARE as bridging or downstaging treatment to LT between January 2006 and April 2021 was performed. TARE-related liver toxicity was assessed. Imaging data were analyzed to assess tumor response. Histopathological analysis of explant livers was performed to assess HCC necrosis. Survival and bridging/downstaging success predictor analysis was performed.

Results: Thirty-six patients underwent resin-based TARE with the intention to bridge (33%) or downstage (67%) to LT. 44% had ≥3 HCC lesions, 53% had bilobar disease. Median largest tumor diameter was 3.4 cm. TARE was segmental, lobar, and bilobar in 20%, 36%, and 44% of cases, respectively. 17% had grade 3 bilirubin toxicities. Objective response rate per mRECIST was 72%. Patients meeting UNOS-DS criteria had higher chances of successful bridging/downstaging. 23 patients were transplanted. Complete pathologic response was seen in 30% of explant livers. Post-transplant tumor recurrence occurred in 26% within a median follow-up period of 1710 days. Estimated 5-year progression-free, disease-specific, and overall survival rates after LT were 89%, 69%, and 89%, respectively. For the entire patient cohort, these rates were 87%, 53% and 70%.

Conclusion: Resin-based ⁹⁰Y TARE can be considered a valuable treatment option for bridging or downstaging patients with HCC to LT, including patients requiring (bi-)lobar TARE for extensive tumoral disease.

Purpose: To evaluate how the implementation of superior hypogastric nerve block (SHNB) during uterine artery embolization (UAE) for uterine fibroids impacts same-day discharge and healthcare encounters (HE) within 30 days.

Materials and methods: 240 patients who underwent successful UAE for fibroids between January 2018 and December 2022 were retrospectively reviewed. HE within 30 days, including emergency department (ED) and urgent care visits, admissions, and readmissions, were categorized as early (0-7 days of discharge) and late (8-30 days of discharge), and related or unrelated to interventional radiology (IR) care. Factors associated with same-day discharge and HE were identified with univariate analyses. Rates of HE based on SHNB status were compared using chi-square tests.

Results: Mean age was 46 ± 5 years; 125 patients received UAE with SHNB. Patients who underwent SHNB were significantly more likely to undergo same-day discharge (113/125, 90%) compared to those without SHNB (55/115, 48%) (p<0.001). There were no factors associated with rates of all-cause 30-day HE, including SHNB status (SHNB 17% (21/125) vs no SHNB 10% (12/115), p=0.20). A majority of HE were due to an IR-related cause (26/33, 79%), including abdominal or pelvic pain (22/33, 67%), nausea, vomiting, or poor oral intake (18/33, 55%), and vaginal bleeding (4/33, 12%). Comparing SHNB to no SHNB patients, there was no difference in the proportion of IR-related HE (17/21 (81%) vs 9/12 (75%), p=0.69).

Conclusions: UAE with SHNB is associated with significantly higher rates of same-day discharge but similar rates of 30-day healthcare encounters, compared to UAE alone.

Purpose: To develop a porcine model for arteriovenous fistula (AVF) venous stenosis treated with percutaneous transluminal angioplasty (PTA) and compare outcomes of plain balloon angioplasty (POBA) to IN.PACT paclitaxel drug-coated balloons (DCB).

Materials and methods: Twelve castrated male Yorkshire pigs (4-5 months, 35-45kg) underwent renal artery embolization to induce chronic kidney disease (CKD). Twenty-eight days later, AVF was created by anastomosing the left external jugular vein to left common carotid artery. The pigs were divided into a pilot group (n=6) for optimizing the AVF technique (euthanized at day 4) and a definitive group (n=6) for validating PTA outcomes (euthanized at day 42). Stenosis developed at juxta-anastomosis 28 days later and was treated with POBA [pilot group (n=6), definitive group (n=3)] or DCB [definitive group only (n=3)]. Definitive group underwent biweekly 4D Flow MRI scans.

Results: All animals developed CKD, with significant increases in BUN (median increase: 2.6 to 3.2 mmol/L, P<0.001) and creatinine (median increase: 100 to 187 μmol/L, P<0.001). In the pilot group, one animal had an infected fistula, and AVF patency was 1/5. In the definitive group, the patency was 5/6 because the AVF technique was modified by resecting the sternomastoid muscle and increasing the spatulation. At day 42 post PTA, DCB treated AVF outflow vein showed increasing blood flow compared to POBA (DCB 209.8 ± 64.42 mm² vs POBA 170.9 ± 95.52 mm² p = 0.934).

Conclusions: A porcine model of AVF venous stenosis treated with PTA was developed, with blood flow trends favoring DCB over POBA.