Journal of Vascular and Interventional Radiology最新文献

Purpose: To investigate the effectiveness and safety of thoracic endovascular aortic repair (TEVAR) for infectious aortic diseases.

Materials and methods: Patients who underwent TEVAR for infectious aortic diseases including infected thoracic aortic aneurysm, aortobronchial fistula (ABF), and aortoenteric fistula from December 2011 to October 2022 at 4 institutions were retrospectively studied. The primary outcome of the study was overall survival, whereas the secondary outcome was comprehensive adverse events. Comprehensive adverse events were defined as a combination of deaths, aortic events, and infectious adverse events.

Results: A total of 28 patients were included in the analysis, with 13 patients having infected thoracic aortic aneurysms, 12 ABFs, and 3 aortoenteric fistulae. Seven patients (25%) underwent additional procedures (abscess drainage, 6 cases; total esophagectomy, 1 case). The mean follow-up period was 30.0 months (SD ± 33.9). The 1-year and 5-year survival rates were 85.7% and 67.9%, respectively. The 1-year and 5-year aorta-related complication-free survival rates were 64.3% and 42.9%, respectively. On univariate analysis, the presence of an ABF was associated with a higher risk of comprehensive adverse events (odds ratio = 11; P = .04).

Conclusions: TEVAR might be a promising treatment for infectious thoracic aortic diseases. Among the infectious pathologies, ABF was considered ominous in terms of late outcomes.

Purpose: To investigate the outcomes of first-line image-guided microwave ablation (MWA) plus tyrosine kinase inhibitors (TKIs) in untreated epidermal growth factor receptor (EGFR)-mutant advanced lung adenocarcinoma (LUAD) and to compare with TKIs alone.

Materials and methods: This retrospective cohort study included patients between December 2015 and December 2021 and was divided into 2 groups (Group A: first-line MWA+TKIs; Group B: TKIs alone). Progression-free survival (PFS) was the primary end point, whereas overall survival (OS) was the secondary end point and were compared via the Kaplan-Meier methods. Univariate and multivariate analyses were used to investigate the predictors of PFS and OS. Propensity score matching (1:1 ratio) was applied between Group B and the subgroup of complete ablation in Group A.

Results: A total of 117 patients were included (Group A: n = 43; Group B: n = 74). In a mean follow-up of 47.0 months (SD ± 19.4), Group A had significantly longer median PFS (19.0 vs 10.0 months; P < .001) and OS (41.0 vs 25.0 months; P = .044) than Group B. Predictors of PFS included first-line MWA (P < .001) and tumor stage (P = .020), while that of OS included first-line MWA (P = 0.039), tumor stage (P = 0.014), and usage of third-generation TKIs (P = 0.001). There were 23 pairs of patients obtained after propensity score matching (Group A1: complete ablation+TKIs; Group B1: TKIs alone). Group A1 had significantly longer median PFS (24.0 vs 10.0 months; P < .001) and OS (48.0 vs 24.0 months; P = .012) than Group B1.

Conclusions: First-line MWA significantly improved the outcomes of patients with untreated EGFR-mutant advanced LUAD treated with TKIs. Complete ablation predicts a better prognosis.

Purpose: To determine how low inorganic phosphate stress (LIPS) induced by sevelamer transartieral embolization (S-TAE) affects immune regulation and angiogenesis in hepatocellular carcinoma (HCC).

Material and methods: Transcatheter arterial embolization (TAE) using conventional lipiodol plus Poly (vinyl alcohol) (PVA) microsphere and S-TAE were conducted on a McA-RH7777 orthotopic liver tumor model in rats, followed by the assessment of alterations in immunity- and angiogenesis-related factors. The cells were cultured under hypoxic conditions and stimulated with LIPS to analyze the modulation of programmed cell death 1 ligand 1 (PD-L1), vascular endothelial growth factor (VEGFα), and transforming growth factor-β1 (TGF-β1) expression through Western blotting, qRT‒PCR, and immunofluorescence assays. Cell migratory capacity and angiogenesis were also evaluated.

Results: TAE increased the expression of neoplastic PD-L1 and VEGFα, and S-TAE, which depletes intratumoral Pi, downregulated the expression of PD-L1, VEGFα and TGF-β1, and augmented the infiltration of CD8+ T-cells, thereby inhibited angiogenesis and activated anticancer immunity. In vitro, the study demonstrated that LIPS inhibits hypoxia-induced upregulation of PD-L1 expression and the HIF-1α/VEGFα axis. Moreover, LIPS inhibited the tube formation ability of Human Umbilical Vein Endothelial Cells (HUVECs) and the migration ability and epithelial-mesenchymal transition (EMT) process of cancer cells under hypoxic conditions.

Conclusions: S-TAE inhibited the expression of PD-L1 and VEGFα, thereby activated anti-tumor immunity and suppressing tumor angiogenesis. All the findings reveal the biology of tumors under low Pi stress and suggest the potential therapeutic value of S-TAE.

Purpose: The guideline regarding the maximum tolerated lung dose for Yttrium-90 (Y90) radioembolization is an expert opinion (level 5 evidence) based on a case series of 5 patients and recommends keeping the absorbed radiation dose to the lungs below 30 Gy per treatment and 50 Gy in a lifetime to prevent radiation pneumonitis (RP). The current understanding of the risks of RP is minimal despite its debilitating nature and high mortality rate. This review evaluates the available evidence of lung dosimetry and RP.

Materials and methods: A systematic literature review was conducted in PubMed, Embase, Cochrane database, and Google Scholar for reported cases of RP. A database of 48 RP cases was compiled and analyzed.

Results: Thirty patients were treated with resin and 16 patients with glass Y90-microspheres. The treatment device was not reported in 2 cases. RP developed a median of 3 months after radioembolization. The mortality rate was 40%. The hepatopulmonary shunt was not significantly different between the glass and the resin group (21.2±14% vs. 15.6±7.5%, p=0.24). The radiation dose to the lungs was significantly higher in patients treated with glass compared to resin Y90-microspheres (41.4±18.4 Gy vs. 21.5±9.9 Gy, p=0.003).

Conclusions: The dose toxicity threshold for resin microspheres is lower than that of glass microspheres. The established 30 Gy dose limit may not be uniformly applicable in all cases and for both devices. The maximum tolerable lung doses should be re-evaluated and the shortcomings of the hepatopulmonary shunt calculation need to be corrected.

A new conformable embolic agent, brand name Obsidio (Boston Scientific Inc), is indicated for embolizing hypervascular tumors and treating peripheral vessel bleeding. It is a non-Newtonian hydrogel that becomes less viscous when shear force is applied. This retrospective study examines the safety and effectiveness of the shear-thinning embolic in a single-academic-center experience. Technical and clinical success were assessed. Adverse events were defined per the SIR Adverse Events Classification. Twenty-seven patients were treated with the shear-thinning embolic in 39 vessels over 28 procedures. Technical success was achieved in 37/39 vessels (95%), with clinical success in 26/28 procedures (93%). There was one treatment-related severe adverse event (3.6%): left gastric artery embolization resulting in ischemia and subtotal gastrectomy (Grade 3). Two patients had mild adverse events (7.1%). Initial experience shows promising effectiveness of this shear-thinning embolic, though because of differences between this embolic and conventional liquid embolics, operator training is required for safe use.