Journal of Vascular and Interventional Radiology最新文献

This study reviews 657 transvenous liver biopsies using a transfemoral transcaval (TFTC) approach performed at a single institution between February 2014 and February 2024, highlighting three severe adverse events (AE). The retrospective review was performed for all TFTC liver biopsies. Technical success was attained in 99.4% of cases (n=653), and histopathological success in 97.1% of cases (n=638). Twenty-three mild (3.5%), one moderate (<1%), and eight severe (1.2%) AEs were reported. Three severe AEs were directly biopsy-related: a gastrointestinal bleed, a gallbladder fossa hemorrhage, and an extrahepatic bile duct leak. Review of the imaging suggests that these biopsies were taken at a point inferior to the intrahepatic inferior vena cava (IVC) which may have led to extrahepatic puncture. The TFTC approach demonstrates a favorable safety and efficacy profile. Importantly, careful attention must be paid to avoid low punctures inferior to the intrahepatic IVC, as they may be associated with AEs.

In the ATTRACT trial, 691 patients were randomized to receive, or not receive, pharmacomechanical catheter-directed thrombolysis (PCDT) to treat acute proximal deep vein thrombosis (DVT). Serious adverse events and suspected PE (collectively, "late symptom events", LSEs) were reported. An independent physician, blinded to treatment allocation, categorized LSEs occurring 1-24 months post-randomization by whether they could relate to post-PE syndrome. PE-related LSEs were frequent (66.7%) in patients who presented with diagnosed or suspected PE and infrequent (2.0%) in others, but PCDT did not influence their occurrence (PCDT 11.0% vs. No-PCDT 11.0%, p=1.000). However, in the iliofemoral DVT subgroup, PCDT Arm patients had fewer PE-related LSEs per patient (PCDT 0.14 vs. No-PCDT 0.24, p=0.036) and fewer PE-related breathing/lung LSEs per patient (PCDT 0.08 vs. No-PCDT 0.16, p=0.023). These findings suggest that assessment for post-PE syndrome after DVT thrombolysis can be focused on studies of iliofemoral DVT patients with PE symptoms at baseline.

Purpose: To prospectively evaluate the safety and efficacy of gallbladder cryoablation in patients with calculous cholecystitis initially treated with percutaneous drainage.

Materials and methods: High-operative risk patients with calculous cholecystitis treated with cholecystostomy tube drainage underwent gallbladder cryoablation. The primary end points were safety, defined as the absence of procedure related adverse events during the follow-up period, and clinical success, defined as the absence of symptoms after cholecystostomy tube removal. The secondary end point was imaging success, defined as gallbladder involution on CT or MRI.

Results: Ten patients underwent gallbladder cryoablation. Mean age was 71+/-10 years (range 53 to 90). Mean ASA score was 3+/-1 (range 2 to 4) and mean modified Frailty Index was 4+/-2 (range 1 to 6). Cholecystostomy tubes were in situ for a mean of 60+/-26 days (range 18 to 94) prior to cryoablation. Mean duration of clinical follow-up was 563+/-152 days (range 326 to 799) and imaging follow-up was 368+/-235 days (range 66 to 792). One infection and one mortality occurred, both in patients with gallstones >20 mm in size, prior pseudomonas infection, and iceball volumes >150 cm³. IRB review concluded that the cause of the mortality was a medication allergy. Clinical and imaging success was achieved in 9 of 10 patients.

Conclusion: Gallbladder cryoablation may be an effective treatment for high-operative risk patients with calculous cholecystitis initially treated with percutaneous drainage, with 90% clinical and imaging success. Optimization of patient selection is indicated, with particular reference to gallstone size and bacterial colonization.

Purpose: To evaluate postpartum hemorrhage (PPH) and Interventional Radiology (IR) service landscapes in Kenya using geospatial analytic mapping for outreach planning.

Materials and methods: Geographic information system (GIS) analysis of Kenya was performed using open-source data sets. Data at the regional and county levels from 2014-2018 were collected to evaluate demographics and variables related to PPH and healthcare access. Population risk indices were created based on these data. Detailed multi-layered GIS mapping was performed to produce visual data representations of the findings for outreach planning.

Results: From 2014 to 2018, the incidence of maternal hemorrhage in Kenya increased by 38%. Six hospitals in Kenya offer the IR services required to treat PPH, all located in Nairobi. Relative to other counties, maternal mortality ratios (MMRs) in Nairobi were near the median, falling within standard deviations of -0.5 to 0.5. MMRs were highest in the southeastern and northwestern regions of the country, with standard deviation increases of 1.5-2.3 and 0.5-1.5 respectively. Risk index and population maps identified high-impact hospitals for IR outreach.

Conclusion: GIS analysis demonstrated disproportionate rates of maternal morbidity and mortality due to PPH in areas without IR capabilities. It proved to be a valuable tool to understand population health and can be leveraged to strategically target global IR services.

Purpose: To evaluate the safety and effectiveness of percutaneous drainage in the management of infected post-cesarean section bladder flap hematomas.

Materials and methods: This retrospective cohort study examined all post-cesarean imaging performed between January 1, 1999, and April 1, 2022. Of 90,462 cesarean sections performed, 255 patients underwent postpartum pelvic imaging. Images were assessed for bladder flap hematoma, and features of infection. Infected bladder flap hematoma was defined by the presence of SIRS criteria for sepsis, with or without imaging features of infection. Treatment approaches, outcomes, hospitalization duration, and readmission were obtained when available. T-test was used for parametric data and Mann-Whitney U test for non-parametric data.

Results: Bladder flap hematoma was diagnosed in 56/255 (22%) patients, with a median age of 31 years (IQR 26.8 - 35.0 years). 45/56 (80%) patients presented with infection and were treated either with antibiotics alone (26/45, 58%) or drainage procedures (19/45, 42%) combined with antibiotics [surgical (3/19, 16%) and percutaneous drainage (16/19, 84%)]. Percutaneous drainage had a success rate of 15/16 (94%). Conservative management with antibiotics alone also had a high success rate of 25/26 (96%), but 1/26 (4%) developed uterine scar dehiscence. The median hospital stay was 4 days (range: 1-12) for the antibiotic-only group and 6 days (range: 3-39) for the drainage group (p<0.01). Readmission within 30 days occurred in 7/26 (27%) patients in the antibiotic group compared to 3/16 (19%) in drainage group.

Conclusion: Percutaneous image-guided drainage is safe and highly effective in managing infected bladder flap hematomas that do not respond to antibiotics with no increased risk of uterine scar dehiscence.

Purpose: To analyze the causes and clinical impacts of endovascular technical failure (ETF) in the BEST-CLI trial, which compared endovascular therapy to bypass surgery in patients with chronic limb-threatening ischemia (CLTI) METHODS: Patients with CLTI were randomized to infrainguinal bypass or endovascular therapy. ETF was defined as the inability to complete the endovascular procedure. Patients with ETF were compared with no ETF. Causes of ETF and impact on major adverse limb event(MALE), above-ankle amputation and death were analyzed. ETF occurred in 16% (146 of 896) of endovascular procedures.

Results: Patients who experienced ETF were older, (69 +10 vs 67+10 yrs, p=.007), less frequently Hispanic, and had more complex infrainguinal arterial occlusive disease versus no ETF. ETF had more multilevel arterial occlusions involving a combination of both the superficial femoral/popliteal (SFA/pop) segments and tibial segments (52% vs 41%, p=.029) , WiFi ischemia grade 3 (70.3% vs 53.1%, p=.002) and occlusion of the proximal SFA (37% vs 19%, p<.001). Causes of ETF included inability to cross the lesion in 82%. Following ETF, 67% underwent bypass surgery within two weeks of ETF. ETF had a higher rate of MALE (81% vs 29%, p <.0001) but similar rates of above-ankle amputation (18.7% vs 16.0%, p=0.0.528) and all-cause death (38.6% vs 29.8%, p=0.260) at 3 years versus no ETF.

Conclusions: ETF occurred in 16% of patients with CLTI and was associated with multilevel occlusions and proximal SFA occlusion. ETF was due to inability to cross the lesion in 82%. It did not impact long-term above-ankle amputation or death but was associated with increased major revascularization.

Purpose: To compare concordance of radiologic and pathologic response of hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE), percutaneous ablation, and multimodal treatment using radiologic-pathologic correlation.

Methods: This single-center retrospective study analyzed 56 treatment naive patients (75% male; 63% BCLC A) with 81 HCC tumors (mean diameter 2.1±0.9 cm) who underwent locoregional therapy (LRT) (TACE n=44, ablation n=10, TACE+ablation n=27) prior to liver transplantation (LT) between 2010-2019. Immediate pre-LT cross-sectional imaging was used to assess modified Response Evaluation Criteria for Solid Tumors (mRECIST) response. Explant liver pathology was reviewed for percent (%) pathologic necrosis (PN). Associations between imaging and pathologic observations were statistically characterized using the Chi-squared and Kruskal-Wallis tests.

Results: Median time from imaging to LT was 37 (range 2-191) days. Across all LRT types, 68% (55/81), 19% (15/81), and 13% (11/83) of tumors displayed mRECIST complete response (CR), partial response (PR), and stable disease (SD). Mean %PN in CR tumors (89±21%) was significantly higher than PR (68±34%, P=0.005) and SD (67±36%, P=0.009). 60% (33/55) of CR tumors showed 100% complete PN (CPN) while only 20% (3/15) of PR and 18% (2/11) of SD showed CPN (P=0.002). There was no association between %PN or CPN across different LRT modalities and radiological response categories, indicating consistent performance between treatments. Sensitivity and specificity for radiologic CR to predict 100% PN was 87% and 49%.

Conclusions: Radiologic-pathologic outcomes herein suggest that radiologic response criteria associate with PN, with no differences across treatment modalities. However, the imperfect predictive capacity of imaging for PN supports surveillance of treated tumors before LT.