Journal of Vascular and Interventional Radiology最新文献

Purpose: To compare changes in hemoglobin (HB) following catheter-directed thrombolysis (CDL) versus large-bore aspiration thrombectomy (LBAT) of acute pulmonary embolism (PE).

Materials and methods: A single-center retrospective review of patients with acute high- or intermediate-risk PE treated with CDL or LBAT between December 2009 and September 2023 was performed. The LBAT group was divided according to usage of an autotransfusion device (ATD). There were 166 patients in the CDL group (56 years ± 15). LBAT patients were treated without (LBAT, n = 58, 61 years ± 16) or with (LBATw, n = 47, 62 years ± 15) an ATD. Endpoints included change in HB between preprocedural and postprocedural measurements, the 7-day postprocedural nadir (low point), and adverse events (AEs).

Results: The mean HB changes between preprocedural and postprocedural measurements in the CDL, LBAT, and LBATw groups were -1.3 g/dL ± 1.3, -1.6 g/dL ± 0.98, and -1.1 g/dL ± 0.9, respectively (P = .098). The mean HB changes to the 7-day postprocedural nadir in the CDL, LBAT, and LBATw groups were -1.7 g/dL (SD ± 1.4), -2.4 g/dL (SD ± 1.3), and -1.8 g/dL (SD ± 1.3), respectively (P = .008). The minor hemorrhagic AE rates were 3.6% in the CDL group, 12.1% in the LBAT group, and 14.9% in the LBATw group (P = .010). There was no significant difference in moderate (P = .079) and major (P = .529) hemorrhagic AEs between the groups. There were no procedure-related mortalities.

Conclusions: The use of LBAT without ATD resulted in a significant decrease in HB to the 7-day postprocedural nadir compared with CDL or LBAT with ATD. This did not translate into significantly higher transfusion rates or moderate or major hemorrhagic events. Findings suggest that the decision between CDL and LBAT should not be based solely on the expected blood loss consideration.

Purpose: To determine the effect of arterial embolization using different embolic agents and sizes on microwave ablation (MWA) zone size in a porcine renal tumor (RT) model.

Materials and methods: In a transgenic porcine kidney, 32 sites were inoculated, with 28 orthotopic RTs induced. Experimental groups (23 tumors) underwent angiography with arterial embolization using various embolic materials (calibrated particles from 40 to 1,200 μm, and ethiodized oil) to achieve vascular stasis of the RT. MWA using a standard protocol (3 minutes at 65 W) was subsequently performed for all tumors. Gross and histologic ex vivo analyses of the ablation zones were performed.

Results: Control group ablation zone volume without prior embolization was 5.24 cm³ (SD ± 0.55). Ablation zones after embolization with 40 μm, 100 μm, 300-500 μm, 900-1,200 μm particles were significantly larger than those with MWA alone (mean, 15.39 cm³ [SD ± 4.54]; P = .002; 11.07 cm³ [SD ± 1.39]; P = .001; 8.68 cm³ [SD ± 0.77]; P = .001; and 9.90 cm³ [SD ± 1.62]; P = .002, respectively). Liquid embolic ethiodized oil emulsion did not create a significant increase in the ablation zone (5.92 cm³ [SD ± 1.43 cm³]; P = .492).

Conclusions: Pre-MWA arterial embolization in a porcine RT model produced a statistically significant increase in the ablation zone when compared with MWA alone. Using smaller particle size embolic material with distal embolization at the tumor arterioles (50-150 μm) produced the largest, almost 3-fold increase in ablation zone volume.

Purpose: To compare the effectiveness of percutaneous transhepatic obliteration (PTO) with initial afferent vein embolization (PTO-A) and with initial efferent vein embolization (PTO-E) for gastric varices (GVs).

Materials and methods: Consecutive patients undergoing PTO-A or PTO-E for type 1 isolated GVs or type 2 gastroesophageal varices between June 2007 and February 2023 were included. PTO-A or PTO-E was indicated when balloon-occluded retrograde transvenous obliteration failed or there was no portosystemic shunt for the retrograde transvenous approach. PTO-A was performed for patients before March 2009 and for patients with multiple efferent channels from the GVs. PTO-E was attempted for patients after April 2009. Twenty-six patients were included, of whom 18 underwent PTO-A and 8 underwent PTO-E. In 12 patients, PTO-E was attempted without success, and they underwent PTO-A instead. The primary outcome was successful complete eradication of GVs within 1 week after the procedure. The secondary outcomes were the GV recurrence-free period and overall survival after the procedure.

Results: Technical success was achieved in all 26 patients, with complete GV eradication rates of 33.3% in PTO-A and 100% in PTO-E, significantly higher in PTO-E (P = .002). The median recurrence-free periods were 8.7 months with PTO-A and 75.1 months with PTO-E; PTO-E had a significantly longer recurrence-free period (P = .042). The median overall survival durations were 37.2 months with PTO-A and 49.9 months with PTO-E, with no significant difference (P = .955).

Conclusions: PTO-E had a better complete eradication rate and longer recurrence-free period than PTO-A for GVs.

Purpose: To evaluate the effectiveness of track cautery for lung microwave ablation (MWA) to reduce postprocedural adverse events (AE).

Materials and methods: Patients who underwent percutaneous lung MWA between 2012 and 2021 were divided into 2 cohorts: patients in whom track cautery was conducted during antenna removal and patients in whom the antenna was simply removed. Patient demographics, treatment history, tumor characteristics, and ablation details were collected. Postprocedural AEs including immediate, enlarging, and delayed pneumothorax (PTX), pleural effusion, and reinterventions were recorded. Univariate and multivariate logistic regression models were used to identify factors associated with AEs.

Results: This study included 365 lung MWA sessions for 190 patients. Of the 165 patients in the cautery cohort, 78 (47%) had immediate PTX, 16 (10%) had enlarging PTX, 2 (1%) had delayed PTX, and 15 (9%) needed interventions. Of the 200 patients in the noncautery cohort, 85 (43%) had immediate PTX, 45 (23%) had enlarging PTX, 16 (8%) had delayed PTX, and 37 (19%) needed interventions. The cautery cohort had significantly reduced rates of enlarging PTX (odds ratio [OR], 0.67; 95% CI, 0.34-1.33; P = .002), delayed PTX (OR, 0.15; 95% CI, 0.03-0.89; P = .037), and pleural effusion (OR, 0.38; 95% CI, 0.15-0.99; P = .049). The presence of emphysema, large tumor size, and left lower lobe location were shown to be significant predictors of AEs and the need for interventions (P < .05).

Conclusions: Track cauterization is associated with reduction of post-MWA enlarging PTX, delayed PTX, and pleural effusion. Presence of emphysema, lack of track cautery, large tumor size, and tumors in the left lower lobe were shown to be predictors of postprocedural AEs.

Purpose: To study the in vivo safety and effectiveness of a novel radiopaque nonadhesive polyacrylate (PA) peripheral liquid embolic system (AMBER SEL-P) relative to ethylene-vinyl alcohol copolymer (EVOH, Onyx) in a healthy swine endovascular model.

Materials and methods: Twenty-five swine underwent rete mirabile and bilateral kidney embolization with PA or EVOH and were followed up for 24 hours (n = 5) and 30 days (n = 10), and 3 (n = 10) months. Angiographic features (penetrability, radiopacity, catheter entrapment, fragmentation, occlusion, and vasospasm) were evaluated. Necropsy and histology were used to evaluate the nontarget embolization, safety, and target embolization effectiveness by recanalization and analyze the vascular response.

Results: No adverse events occurred during the embolization process or study period. The angiographic performance confirmed a significant positive effect of PA compared with that of EVOH in terms of penetrability (P = .007), catheter entrapment (P = .007), fragmentation (P = .007), vascular occlusion (P = .038), vasospasm (P = .038), and follow-up vascular occlusion (P = .038). Prenecropsy angiography found no vascular recanalization in the organs treated with PA, whereas it was detected at 3 months in 2 samples treated with EVOH. Histologically, PA was classified as nonirritant compared with EVOH under the study conditions according to ISO 10993-6:2016 as modified. No systemic effects during necropsy were detected in the animals treated with these agents.

Conclusions: This in vivo study found that the angiographic behavior of PA had advantages compared with EVOH. The embolization and biocompatibility of PA were similar to those of EVOH. PA was safe and effective for transarterial embolization in an acute, subacute, and chronic endovascular embolization animal models.

Purpose: To evaluate the potential of interpretable machine learning (ML) models to predict ascites improvement in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement for refractory ascites.

Materials and methods: In this retrospective study, 218 patients with refractory ascites who underwent TIPS placement were analyzed. Data on 29 demographic, clinical, and procedural features were collected. Ascites improvement was defined as reduction in the need of paracentesis by 50% or more at the 1-month follow-up. Univariate statistical analysis was performed. Data were split into train and test sets. Feature selection was performed using a wrapper-based sequential feature selection algorithm. Two ML models were built using support vector machine (SVM) and CatBoost algorithms. Shapley additive explanations values were calculated to assess interpretability of ML models. Performance metrics were calculated using the test set.

Results: Refractory ascites improved in 168 (77%) patients. Higher sodium (Na; 136 mEq/L vs 134 mEq/L; P = .001) and albumin (2.91 g/dL vs 2.68 g/dL; P = .03) levels, lower creatinine levels (1.01 mg/dL vs 1.17 mg/dL; P = .04), and lower Model for End-stage Liver Disease (MELD) (13 vs 15; P = .01) and MELD-Na (15 vs 17.5, P = .002) scores were associated with significant improvement, whereas main portal vein puncture was associated with a lower improvement rate (P = .02). SVM and CatBoost models had accuracy ratios of 83% and 87%, with area under the curve values of 0.83 and 0.87, respectively. No statistically significant difference was found between performances of the models in DeLong test (P = .3).

Conclusions: ML models may have potential in patient selection for TIPS placement by predicting the improvement in refractory ascites.

The goal of this study was to evaluate whether there is an association between academic productivity and National Institutes of Health (NIH) grant funding among academic interventional radiologists. A database containing board-certified U.S. interventional radiologists was previously created for a study evaluating the Hirsch index (h-index) in 2021. The Scopus database was used to add the h-index values for 2023. The NIH RePORTER system was queried to collect any data on NIH grant funding received by each interventional radiologist. Among the 832 interventional radiologists, 37 physicians received NIH grant funding (33 males and 4 females). Bivariate analysis showed that h-index and length of publication range were both positively and significantly correlated with NIH grant funding (coefficients, $731,696 [P < .001] and $2,957,922 [P < .001], respectively). However, no significant differences in NIH grant funding were found across academic ranks (P = .430) or genders (P = .906). h-Index was significantly associated with higher NIH grant funding received by interventional radiologists.

Acute portomesenteric venous thrombosis (PVT) is a rare but potentially life-threatening condition in individuals without cirrhosis. Initial management typically involves anticoagulation therapy, but the optimal approach to interventional treatment remains a topic of ongoing research. This article explores both traditional and emerging endovascular techniques, providing an overview of the existing evidence supporting their use. Additionally, it delves into the significance of acute PVT in the context of contemporary pathologies, notably coronavirus disease 2019 infection, vaccine-induced immune thrombotic thrombocytopenia, and liver transplantation.