Journal of Vascular and Interventional Radiology最新文献

Purpose: To evaluate the feasibility, safety, and early outcomes of percutaneous image-guided screw fixation (PIGSF) for radiation induced pelvic insufficiency fractures (R-PIFs).

Methods: We retrospectively analyzed consecutive patients with symptomatic R-PIFs treated by PIGSF under CT or cone-beam CT guidance between January 2021 and January 2024 in three tertiary centers. Screws were positioned via transsacroiliac approaches, with cement injected into the fracture site and screw trajectory. Clinical evaluation included pain, analgesic use, mobility, and patient-reported quality of life (QoL). Follow-up included standardized consultation and CT at one month.

Results: Eighteen patients (mean age 71.0 ± 6.5 years, 61% women) were included. Technical success was achieved in all interventions, with a median procedure duration of 63 minutes (range 45-90). A total of 32 screws were implanted (mean 1.8 per procedure). No intraoperative or early adverse events occurred. All patients were able to stand up and walk within 24 hours, and 17/18 were discharged on day one. At one month, maximal pain decreased from 8.6 ± 1.8 to 3.3 ± 2.8 (p < 0.0001), and average pain from 7.2 ± 2.0 to 2.0 ± 1.8 (p < 0.0001). QoL improved from 40.0 ± 22.4 to 72.3 ± 22.4 (p = 0.0036).

Conclusion: PIGSF for R-PIFs is technically feasible, safe, and associated with rapid pain relief, early mobilization, and improved QoL.

Purpose: To evaluate the safety, technical success, and short-term clinical efficacy of the Low-profile Braided Occluder (LOBO) device for embolization of pulmonary arteriovenous malformations (PAVMs).

Materials and methods: A single-center retrospective study of 23 consecutive patients (mean 42.3 + 19 years; 82% female) with PAVMs underwent transcatheter embolization using LOBO devices. Clinical efficacy was defined as the absence of PAVM recanalization/persistence and ≥70% reduction in sac size on 6-month follow-up CT angiography (CTA). Adverse events were also assessed following embolization.

Results: Of the twenty-three patients treated, 87% had Hereditary Hemorrhagic Telangiectasia. Fifty-nine feeding arteries were embolized using a single device per feeder (LOBO-3, n=37; LOBO-5, n=18; LOBO-7, n=3; LOBO-9, n=1) with no additional coils or other embolic devices required. Mean feeding-artery diameter was 2.93+1.05 mm. The mean fluoroscopy time was 29.19 + 20 minutes (Median:24.9 minutes; Range: 4.6-106.9 minutes), and mean radiation dose was 623.5 + 598 mGy (Median:404 mGy; Range: 18-3135 mGy). Technical success was 100%, with no intraprocedural device mal-deployment or migration. At imaging follow-up of approximately 6 months (Mean 251+74.55 days, Median 266 days, Range 154 - 474 days), there was no recanalization of treated arterial feeders and nopersistence or recanalization of the PAVM sac. No device-related adverse events or major procedure-related adverse events were observed.

Conclusions: In this single-center experience, the LOBO device appears to be a safe and effective option for PAVM embolization, with promising short-term results.

Objective: To evaluate the feasibility and early outcomes of single session percutaneous cholecystolithotomy using holmium laser lithotripsy with primary tract closure by cholecystopexy in patients with symptomatic gallbladder stones.

Methods: This retrospective study included 30 patients (mean age 34.9 ± 11.3 years; 64.4% female) with symptomatic gallbladder stones who underwent single-stage percutaneous cholecystolithotomy with primary tract closure between July 2023 and December 2024. A 16F access sheath and rigid endoscope were used for gallbladder endoscopy, with stone fragmentation via Holmium laser lithotripsy and removal using a basket, the access tract was primarily closed after the procedure. Clinical scuccess was defined as complete stone clearance. Adverse events were classified by SIR classification RESULTS: The mean stone size was 14.2 ± 5.9 mm; and 80% had stones ≥10 mm; mean gallbladder (GB) ejection fraction measured by ultrasound was 71.8 ± 13.1%. Complete stone clearance was achieved in all cases. Mean procedure time was 48 ± 12 minutes. Primary tract closure was successful in 27 of 30 patients (90%), with no evidence of bile leak following drain removal. Mean drainage duration was 3.3 ± 3.8 days; 76.7% required drainage for 1-3 days. Mean hospital stay was 2.9 ± 2.1 days. Adverse events occurred in 5 patients (16.7%), including bleeding (6.7%) and bile leakage (10%) and none requiring cholecystectomy The mean follow-up duration was 14.5 ± 5.2 months, with two patients showing stone recurrence.

Conclusions: Single session of percutaneous cholecystolithotomy with primary tract closure is a feasible and effective method for symptomatic gallbladder stones .

This report aimed to evaluate trial without catheter (TWOC) success after PAE in catheterized men who had failed medical management and to identify predictors of success and retreatment patterns. Retrospective single-center exploratory analysis included 53 consecutive catheterized men undergoing PAE between January 2019 and March 2025. TWOC succeeded in 29/53 patients (54.7%), lower than prior series, likely reflecting the chronic catheter-dependent cohort and lower bilateral embolization rate. Among successful cases, 2/29 (6.9%) experienced recurrent retention within 1 year. Bilateral embolization was associated with higher success (p=0.024) and independently predicted TWOC success (OR 3.38, 95% CI). Larger prostate volume showed a non-significant trend toward success (p=0.066). Among 24 initial TWOC failures, 13 underwent surgical retreatment at a median of 9.0 months (IQR 5.5-15.7); 11/13 achieved catheter independence. PAE may represent a pragmatic second-line option in chronically catheterized men when endoscopic surgery is unsuitable or their side effects are undesirable.

Purpose: To evaluate the safety and effectiveness of intravascular lithotripsy (SEISMIQ Intravascular Lithotripsy (IVL) System; Boston Scientific Corporation; Marlborough, MA) for treating calcified above-the-knee (ATK) lesions in patients with peripheral artery disease.

Materials and methods: RESTORE ATK was a prospective, single-arm study that enrolled from ten sites between 20-Jan-2023 and 13-Dec-2023. Ninety-five patients with de novo, moderate to severe calcifications of the femoropopliteal segments were treated using the tested device to modify calcium. Adjunctive drug-eluting technology was not permitted. Primary endpoints were <50% residual diameter stenosis post-IVL treatment (by independent core laboratory-adjudicated angiography), and 30-day incidence of major adverse events (MAE): death, clinically-driven target lesion revascularization (CD-TLR), or major amputation. Secondary endpoints included patency, ankle-brachial index (ABI), and Rutherford classification (RC) through 6 months.

Results: Baseline RC included RC2 (23.2%), RC3 (70.5%), or RC4 (6.3%). Lesions averaged 96.0mm in length, with 93.7% severely calcified and a mean baseline diameter stenosis of 93.7%. Post-procedure residual stenosis <50% was achieved in all patients, meeting the pre-defined performance goal. Only three patients (3.2%) received provisional stenting. Patients had a mean residual stenosis of 21.2% and acute luminal gain of 3.2 mm. No MAEs occurred through 30-day follow-up. At 6 months, target lesion patency was 66.3% and freedom from CD-TLR was 97.9%. A high proportion of patients demonstrated ≥1 RC improvement at 30-day (93.5%) and 6-month (91.2%) follow-up.

Conclusion: This IVL system demonstrated effective treatment of calcified ATK lesions by successfully reducing calcific stenoses with minimal complications and sustained clinical improvement through 6 months.

Purpose: To evaluate the safety and accuracy of robotic-assisted microwave ablation (MWA) for primary and secondary liver tumors using the Epione™ (Quantum Surgical) robotic system.

Materials and methods: This single-center retrospective study included all CT-guided robotic MWA procedures from May 2023 to March 2025. Primary endpoints were safety, assessed by adverse events related to robotic guidance or ablation, and accuracy, defined by the need for minor (depth/lateral) or major (reinsertion) adjustments. Secondary endpoints included feasibility, technical success, local tumor progression (LTP), LTP-free survival (LTPFS), and local control (LC).

Results: A total of 153 robotic-assisted antenna placements were performed to treat 152 tumors in 78 patients. Robotic placement was feasible in 98.7% of patients (77/78). Technical success was achieved in 96.8% of trajectories (152/157). Among all trajectories, 18.5% (29/157) required no adjustment, 62.4% (98/157) required minor depth adjustment, 17.8% (28/157) required minor lateral adjustment, and 3.2% (5/157) required major adjustment. Of major adjustments, four were corrected with robotic reinsertion and one manually. Mean pre-adjustment lateral deviation was 5.6 mm (±3.9). Adverse events occurred in 14.1% of procedures (11 grade 1, 2 grade 2, 1 grade 3), none directly related to robotic guidance. Median follow-up was 6.9-month. The 6-months LTPFS per-tumor for patients treated in the first vs second year was 87.1%, 94.9%, respectively; HR 0.385, 95% CI (0.083 - 1.771); p 0.220).

Conclusion: Robotic guidance for liver MWA demonstrated high feasibility, excellent technical success, and low placement error with no robot-related complications, supporting its safety and accuracy in clinical practice.