I. Theodoulou, Matthew Matson, O. Jaffer, Amr Elsaadany, Deborah Low, Ian Renfrew, Mohammed Rashid Akhtar
Objective This retrospective case series reports the 15-year experience of the endovascular management of mycotic aortic and iliac aneurysms (MAAs) at a tertiary referral center in the United Kingdom. Materials and Methods The patients were identified through advanced searches in picture archiving and communication system (PACS) and electronic patient records. Data were retrieved and recorded in a structured spreadsheet including demographic details, symptoms and comorbidities, endovascular techniques employed and graft types, as well as treatment outcomes including 30-day mortality, 1-, 3-, and 5-year survival, aneurysm resolution percentage, and rates of re-intervention and complications. Statistical Analysis Descriptive statistics summarized the demographic and clinical characteristics, presenting them as means for continuous variables and frequencies/percentages for categorical variables. Results Of the 15 included patients, 73.3% (11/15) and 26.7% (4/15) were males and females, respectively, with a mean age of 64 years. Imaging revealed diverse anatomical involvement, with MAA in the descending thoracic (6/15), suprarenal and juxtarenal (5/15), infrarenal (3/15), and common iliac arteries (1/15). The 30-day mortality rate was 6.7% (1/15), while 1-, 3-, and 5-year survival rates from time of initial intervention were 57.1% (8/14), 38.5% (5/13), and 30.8% (4/13), respectively, with 1 case only just having undergone 1-month follow-up (performed in July 2023). The average mycotic aneurysm size was 47 mm (range: 19–80 mm), of which 33.3% (5/15) presented with rupture. The average sac size reduction following treatment was 31%, with 5/15 cases demonstrating complete resolution. Four cases required re-intervention due to persistent endoleak, sac re-expansion secondary to delayed endoleak, or stent occlusion. Persistent or recurrent graft infection was observed in 53.3% (8/15) of cases. Two cases required surgical re-intervention for stent occlusion. Conclusion Our findings reinforce the role of endovascular interventions in MAA acute management, showcasing immediate survival benefits. Late complications and frequent re-interventions emphasize the importance of vigilant surveillance.
{"title":"Endovascular Treatment of Mycotic Aortic and Iliac Aneurysms in a Tertiary Center: A 15-Year Experience","authors":"I. Theodoulou, Matthew Matson, O. Jaffer, Amr Elsaadany, Deborah Low, Ian Renfrew, Mohammed Rashid Akhtar","doi":"10.1055/s-0044-1787695","DOIUrl":"https://doi.org/10.1055/s-0044-1787695","url":null,"abstract":"\u0000 Objective This retrospective case series reports the 15-year experience of the endovascular management of mycotic aortic and iliac aneurysms (MAAs) at a tertiary referral center in the United Kingdom.\u0000 Materials and Methods The patients were identified through advanced searches in picture archiving and communication system (PACS) and electronic patient records. Data were retrieved and recorded in a structured spreadsheet including demographic details, symptoms and comorbidities, endovascular techniques employed and graft types, as well as treatment outcomes including 30-day mortality, 1-, 3-, and 5-year survival, aneurysm resolution percentage, and rates of re-intervention and complications.\u0000 Statistical Analysis Descriptive statistics summarized the demographic and clinical characteristics, presenting them as means for continuous variables and frequencies/percentages for categorical variables.\u0000 Results Of the 15 included patients, 73.3% (11/15) and 26.7% (4/15) were males and females, respectively, with a mean age of 64 years. Imaging revealed diverse anatomical involvement, with MAA in the descending thoracic (6/15), suprarenal and juxtarenal (5/15), infrarenal (3/15), and common iliac arteries (1/15). The 30-day mortality rate was 6.7% (1/15), while 1-, 3-, and 5-year survival rates from time of initial intervention were 57.1% (8/14), 38.5% (5/13), and 30.8% (4/13), respectively, with 1 case only just having undergone 1-month follow-up (performed in July 2023). The average mycotic aneurysm size was 47 mm (range: 19–80 mm), of which 33.3% (5/15) presented with rupture. The average sac size reduction following treatment was 31%, with 5/15 cases demonstrating complete resolution. Four cases required re-intervention due to persistent endoleak, sac re-expansion secondary to delayed endoleak, or stent occlusion. Persistent or recurrent graft infection was observed in 53.3% (8/15) of cases. Two cases required surgical re-intervention for stent occlusion.\u0000 Conclusion Our findings reinforce the role of endovascular interventions in MAA acute management, showcasing immediate survival benefits. Late complications and frequent re-interventions emphasize the importance of vigilant surveillance.","PeriodicalId":507357,"journal":{"name":"The Arab Journal of Interventional Radiology","volume":"130 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141656603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The effective treatment of various diseases requires not only medications but also precise delivery methods to the body and specific organs. In this regard, radiology plays a crucial role, acting as the eyes of physicians. In contrast, interventional radiology serves as its hands, acting as one of the most effective drug delivery systems. Among interventional radiology disciplines, arterial drug delivery through arteries holds paramount importance as organs primarily receive nourishment directly from them. Furthermore, regenerative medicine is a burgeoning field dedicated to repairing diverse body tissues without relying on pharmaceutical drugs. Stem cells, inherent in various parts of our bodies, are vital for tissue regeneration and reconstruction. Depending on the treatment approach, stem cells can be sourced from the patient's body (autologous) or another individual (allogeneic). There exist various types of stem cells across species, with regenerative properties observed in animals and even plants. However, targeted cell therapy is preferred over systematic injections throughout the body for better efficacy. This article aims to familiarize interventionalists with stem cells and provide them with a clear and helpful explanation of their functions, mechanisms of action, different sources, and other relevant aspects. This will help them select the most appropriate cells for their therapeutic purposes. By comprehensively understanding the significance of stem cells in interventional radiology, we can implement optimal methodologies to address diverse medical conditions efficiently.
{"title":"Simplifying Stem Cell Therapy for IRs: Exploring New Horizons in Interventional Radiology and Cell Therapy","authors":"Hossein Ghanaati, Maedeh Rouzbahani","doi":"10.1055/s-0044-1787158","DOIUrl":"https://doi.org/10.1055/s-0044-1787158","url":null,"abstract":"Abstract The effective treatment of various diseases requires not only medications but also precise delivery methods to the body and specific organs. In this regard, radiology plays a crucial role, acting as the eyes of physicians. In contrast, interventional radiology serves as its hands, acting as one of the most effective drug delivery systems. Among interventional radiology disciplines, arterial drug delivery through arteries holds paramount importance as organs primarily receive nourishment directly from them. Furthermore, regenerative medicine is a burgeoning field dedicated to repairing diverse body tissues without relying on pharmaceutical drugs. Stem cells, inherent in various parts of our bodies, are vital for tissue regeneration and reconstruction. Depending on the treatment approach, stem cells can be sourced from the patient's body (autologous) or another individual (allogeneic). There exist various types of stem cells across species, with regenerative properties observed in animals and even plants. However, targeted cell therapy is preferred over systematic injections throughout the body for better efficacy. This article aims to familiarize interventionalists with stem cells and provide them with a clear and helpful explanation of their functions, mechanisms of action, different sources, and other relevant aspects. This will help them select the most appropriate cells for their therapeutic purposes. By comprehensively understanding the significance of stem cells in interventional radiology, we can implement optimal methodologies to address diverse medical conditions efficiently.","PeriodicalId":507357,"journal":{"name":"The Arab Journal of Interventional Radiology","volume":"3 8","pages":"054 - 062"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141701023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. M. Tahir, Trevor K. Lewis, Aamir Ali, M. Hsu, Jeffrey L. Weinstein, Muneeb Ahmed, Ammar Sarwar
Objective The aim of this study was to evaluate overdilation of 10-mm standard and 8–10 mm controlled-expansion Viatorr stents to 12 mm during transjugular intrahepatic portosystemic shunt (TIPS) placement when insufficient reduction (<50%) in portosystemic gradient (PSG) is achieved with standard 10 mm dilation. Materials and Methods It is a single-institution, institutional review board-approved, retrospective review of TIPS (2013–2022) to identify patients in the overdilation group (12 mm dilation of a 10-mm stent) and a control group (10 mm dilation of a 10-mm stent) matched for age, indication, stent type, Model for End-Stage Liver Disease (MELD) score, pre-TIPS PSG, and variceal embolization. Stent diameter, technical success, clinical outcomes, and adverse events were assessed for both groups. Results TIPS was created for the overdilation group (n = 35, 57 ± 11 years, 69% male; MELD: 14 ± 5) and control group (n = 35, 57 ± 11 years, 83% male; MELD: 14 ± 5). Overdilation to 12 mm adequately reduced PSG by more than 50% (55 vs. 65% in the control group, p = 0.11). The stent diameter was larger in the overdilation group on cross-sectional imaging (9.8 ± 0.2 vs. 9.5 ± 0.4 mm, p < 0.001), with an estimated 57% higher volume flow rate (p = 0.002). Patients were followed for a median of 11.3 months (range: 0.03–75) and 15.6 months (range: 0.03–106) in the overdilation and control groups, respectively. There was an equivalent rate of ascites resolution (56 vs. 63%, p = 0.68) and rebleeding (13 vs. 17%, p = 0.82) in the overdilation and control groups, with a similar risk of new-onset hepatic encephalopathy (41 vs. 33%, p = 0.51) and TIPS occlusion (11 vs. 9%, p = 0.69). Overdilation did not result in any instance of stent fracture. Conclusion Overdilation of 10-mm Viatorr stents with 12 mm balloons may provide benefit by potentially reducing PSG further for patients initially having inadequate PSG reduction with short-term safety.
{"title":"Safety and Efficacy of Overdilation of 10 mm Viatorr Transjugular Intrahepatic Portosystemic Shunt Stents Using 12 mm Balloons","authors":"M. M. Tahir, Trevor K. Lewis, Aamir Ali, M. Hsu, Jeffrey L. Weinstein, Muneeb Ahmed, Ammar Sarwar","doi":"10.1055/s-0044-1782662","DOIUrl":"https://doi.org/10.1055/s-0044-1782662","url":null,"abstract":"\u0000 Objective The aim of this study was to evaluate overdilation of 10-mm standard and 8–10 mm controlled-expansion Viatorr stents to 12 mm during transjugular intrahepatic portosystemic shunt (TIPS) placement when insufficient reduction (<50%) in portosystemic gradient (PSG) is achieved with standard 10 mm dilation.\u0000 Materials and Methods It is a single-institution, institutional review board-approved, retrospective review of TIPS (2013–2022) to identify patients in the overdilation group (12 mm dilation of a 10-mm stent) and a control group (10 mm dilation of a 10-mm stent) matched for age, indication, stent type, Model for End-Stage Liver Disease (MELD) score, pre-TIPS PSG, and variceal embolization. Stent diameter, technical success, clinical outcomes, and adverse events were assessed for both groups.\u0000 Results TIPS was created for the overdilation group (n = 35, 57 ± 11 years, 69% male; MELD: 14 ± 5) and control group (n = 35, 57 ± 11 years, 83% male; MELD: 14 ± 5). Overdilation to 12 mm adequately reduced PSG by more than 50% (55 vs. 65% in the control group, p = 0.11). The stent diameter was larger in the overdilation group on cross-sectional imaging (9.8 ± 0.2 vs. 9.5 ± 0.4 mm, p < 0.001), with an estimated 57% higher volume flow rate (p = 0.002). Patients were followed for a median of 11.3 months (range: 0.03–75) and 15.6 months (range: 0.03–106) in the overdilation and control groups, respectively. There was an equivalent rate of ascites resolution (56 vs. 63%, p = 0.68) and rebleeding (13 vs. 17%, p = 0.82) in the overdilation and control groups, with a similar risk of new-onset hepatic encephalopathy (41 vs. 33%, p = 0.51) and TIPS occlusion (11 vs. 9%, p = 0.69). Overdilation did not result in any instance of stent fracture.\u0000 Conclusion Overdilation of 10-mm Viatorr stents with 12 mm balloons may provide benefit by potentially reducing PSG further for patients initially having inadequate PSG reduction with short-term safety.","PeriodicalId":507357,"journal":{"name":"The Arab Journal of Interventional Radiology","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140683760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mizuki Ozawa, M. Sone, S. Sugawara, Yasuaki Arai, Masahiko Kusumoto
Purpose The aim of this study was to evaluate the differences in antithrombotic therapy policies for inferior vena cava (IVC) stent placement among institutions and interventional radiologists in Japan. Materials and Methods The cross-sectional online-based questionnaire was conducted between December 2022 and January 2023, and a total of 114 institutions were included in this study. The questionnaire contained eight questions that were grouped into three sections: (1) whether IVC stents have been performed or not, (2) the number of IVC stent placements, and (3) the basic strategy of antithrombotic therapy for pre-, intra-, and post-IVC stent placement. Results Of the 114 institutions, 38 responses (33%) were collected. Twenty-four of the 38 institutions (63%) had performed IVC stent placement during the study period. The mean number of IVC stent placements during the study period was 3.4 cases per institution. The most frequently selected antithrombotic therapeutic strategies pre-, intra-, and post-stenting were no antithrombotic therapy (62.5%), anticoagulation therapy (54.2%), and no antithrombotic therapy (41.7%). Conclusion This study has revealed there is no consensus regarding antithrombotic therapy for IVC stent placement in Japan. The results of this study may contribute to our understanding of the status of antithrombotic therapy for IVC stent placement. Future prospective studies are warranted to clarify the periprocedural antithrombotic therapy for IVC stent placement.
{"title":"Antithrombotic Therapy for Inferior Vena Cava Stenting of Malignant Inferior Vena Cava Syndrome: A Questionnaire Study of Japan Interventional Radiology Study Group (JIVROSG)","authors":"Mizuki Ozawa, M. Sone, S. Sugawara, Yasuaki Arai, Masahiko Kusumoto","doi":"10.1055/s-0044-1782693","DOIUrl":"https://doi.org/10.1055/s-0044-1782693","url":null,"abstract":"\u0000 Purpose The aim of this study was to evaluate the differences in antithrombotic therapy policies for inferior vena cava (IVC) stent placement among institutions and interventional radiologists in Japan.\u0000 Materials and Methods The cross-sectional online-based questionnaire was conducted between December 2022 and January 2023, and a total of 114 institutions were included in this study. The questionnaire contained eight questions that were grouped into three sections: (1) whether IVC stents have been performed or not, (2) the number of IVC stent placements, and (3) the basic strategy of antithrombotic therapy for pre-, intra-, and post-IVC stent placement.\u0000 Results Of the 114 institutions, 38 responses (33%) were collected. Twenty-four of the 38 institutions (63%) had performed IVC stent placement during the study period. The mean number of IVC stent placements during the study period was 3.4 cases per institution. The most frequently selected antithrombotic therapeutic strategies pre-, intra-, and post-stenting were no antithrombotic therapy (62.5%), anticoagulation therapy (54.2%), and no antithrombotic therapy (41.7%).\u0000 Conclusion This study has revealed there is no consensus regarding antithrombotic therapy for IVC stent placement in Japan. The results of this study may contribute to our understanding of the status of antithrombotic therapy for IVC stent placement. Future prospective studies are warranted to clarify the periprocedural antithrombotic therapy for IVC stent placement.","PeriodicalId":507357,"journal":{"name":"The Arab Journal of Interventional Radiology","volume":" March","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140682776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endovascular management of narrow-necked aneurysms has traditionally been with coil embolization; however, wide-necked aneurysms have been more difficult to treat due to risk of distal coil migration or intrusion into a parent vessel. We describe the case of a 76-year-old female who presented with a left-sided renal artery aneurysm and 11 mm aneurysm neck. Renal arteriography of the superior pole branch was performed, lower pole was stented, and a retrievable stent was placed in the inferior branch for the purpose of stent-assisted coiling. Penumbra detachable coils were deposited through the stent struts to jail them in with successful embolization of the aneurysm. Endovascular treatment of wide-neck renal artery aneurysms has the potential to be a successful treatment alternative in patients where surgical intervention is contraindicated. Additional studies should be performed to determine the versatility and extent of success in coil embolization for wide-neck aneurysms.
{"title":"Wide-Neck Renal Artery Aneurysm Managed with Neuro-Retrievable Stent-Assisted Coil Embolization","authors":"Eshani J. Choksi, Shivam Kaushik, Venkat Tummala","doi":"10.1055/s-0044-1782665","DOIUrl":"https://doi.org/10.1055/s-0044-1782665","url":null,"abstract":"Endovascular management of narrow-necked aneurysms has traditionally been with coil embolization; however, wide-necked aneurysms have been more difficult to treat due to risk of distal coil migration or intrusion into a parent vessel. We describe the case of a 76-year-old female who presented with a left-sided renal artery aneurysm and 11 mm aneurysm neck. Renal arteriography of the superior pole branch was performed, lower pole was stented, and a retrievable stent was placed in the inferior branch for the purpose of stent-assisted coiling. Penumbra detachable coils were deposited through the stent struts to jail them in with successful embolization of the aneurysm. Endovascular treatment of wide-neck renal artery aneurysms has the potential to be a successful treatment alternative in patients where surgical intervention is contraindicated. Additional studies should be performed to determine the versatility and extent of success in coil embolization for wide-neck aneurysms.","PeriodicalId":507357,"journal":{"name":"The Arab Journal of Interventional Radiology","volume":" 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140684864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. O. Togunwa, Abdulquddus Ajibade, Christabel I. Uche-Orji, Richard Olatunji
The increasing integration of artificial intelligence (AI) in healthcare, particularly in vascular and interventional radiology (VIR), has opened avenues for enhanced efficiency and precision. This narrative review delves into the potential applications of large language models (LLMs) in VIR, with a focus on Chat Generative Pre-Trained Transformer (ChatGPT) and similar models. LLMs, designed for natural language processing, exhibit promising capabilities in clinical decision-making, workflow optimization, education, and patient-centered care. The discussion highlights LLMs' ability to analyze extensive medical literature, aiding radiologists in making informed decisions. Moreover, their role in improving clinical workflow, automating report generation, and intelligent patient scheduling is explored. This article also examines LLMs' impact on VIR education, presenting them as valuable tools for trainees. Additionally, the integration of LLMs into patient education processes is examined, highlighting their potential to enhance patient-centered care through simplified and accurate medical information dissemination. Despite these potentials, this paper discusses challenges and ethical considerations, including AI over-reliance, potential misinformation, and biases. The scarcity of comprehensive VIR datasets and the need for ongoing monitoring and interdisciplinary collaboration are also emphasized. Advocating for a balanced approach, the combination of LLMs with computer vision AI models addresses the inherently visual nature of VIR. Overall, while the widespread implementation of LLMs in VIR may be premature, their potential to improve various aspects of the discipline is undeniable. Recognizing challenges and ethical considerations, fostering collaboration, and adhering to ethical standards are essential for unlocking the full potential of LLMs in VIR, ushering in a new era of healthcare delivery and innovation.
人工智能（AI）越来越多地融入医疗保健领域，尤其是血管和介入放射学（VIR），为提高效率和精确度开辟了途径。这篇叙述性综述深入探讨了大型语言模型（LLMs）在血管和介入放射学中的潜在应用，重点是聊天生成预训练转换器（ChatGPT）和类似模型。LLMs 专为自然语言处理而设计，在临床决策、工作流程优化、教育和以患者为中心的护理等方面具有广阔的应用前景。讨论强调了 LLMs 分析大量医学文献的能力，有助于放射科医生做出明智的决策。此外，文章还探讨了 LLM 在改进临床工作流程、自动生成报告和智能安排病人时间方面的作用。这篇文章还探讨了 LLM 对 VIR 教育的影响，将其视为受训人员的宝贵工具。此外，本文还探讨了将 LLMs 融入病人教育过程的问题，强调了 LLMs 通过简化和准确的医疗信息传播来加强以病人为中心的护理的潜力。尽管存在这些潜力，本文仍讨论了挑战和伦理方面的考虑，包括对人工智能的过度依赖、潜在的错误信息和偏见。本文还强调了综合 VIR 数据集的稀缺性以及持续监测和跨学科合作的必要性。LLM 与计算机视觉人工智能模型的结合提倡一种平衡的方法，以解决 VIR 固有的视觉特性。总之，虽然在 VIR 中广泛实施 LLMs 可能为时尚早，但它们在改进该学科各个方面的潜力是不可否认的。认识到挑战和伦理方面的考虑、促进合作以及遵守伦理标准，对于充分释放 LLM 在 VIR 中的潜力、开创医疗保健服务和创新的新时代至关重要。
{"title":"Exploring the Potentials of Large Language Models in Vascular and Interventional Radiology: Opportunities and Challenges","authors":"T. O. Togunwa, Abdulquddus Ajibade, Christabel I. Uche-Orji, Richard Olatunji","doi":"10.1055/s-0044-1782663","DOIUrl":"https://doi.org/10.1055/s-0044-1782663","url":null,"abstract":"The increasing integration of artificial intelligence (AI) in healthcare, particularly in vascular and interventional radiology (VIR), has opened avenues for enhanced efficiency and precision. This narrative review delves into the potential applications of large language models (LLMs) in VIR, with a focus on Chat Generative Pre-Trained Transformer (ChatGPT) and similar models. LLMs, designed for natural language processing, exhibit promising capabilities in clinical decision-making, workflow optimization, education, and patient-centered care. The discussion highlights LLMs' ability to analyze extensive medical literature, aiding radiologists in making informed decisions. Moreover, their role in improving clinical workflow, automating report generation, and intelligent patient scheduling is explored. This article also examines LLMs' impact on VIR education, presenting them as valuable tools for trainees. Additionally, the integration of LLMs into patient education processes is examined, highlighting their potential to enhance patient-centered care through simplified and accurate medical information dissemination. Despite these potentials, this paper discusses challenges and ethical considerations, including AI over-reliance, potential misinformation, and biases. The scarcity of comprehensive VIR datasets and the need for ongoing monitoring and interdisciplinary collaboration are also emphasized. Advocating for a balanced approach, the combination of LLMs with computer vision AI models addresses the inherently visual nature of VIR. Overall, while the widespread implementation of LLMs in VIR may be premature, their potential to improve various aspects of the discipline is undeniable. Recognizing challenges and ethical considerations, fostering collaboration, and adhering to ethical standards are essential for unlocking the full potential of LLMs in VIR, ushering in a new era of healthcare delivery and innovation.","PeriodicalId":507357,"journal":{"name":"The Arab Journal of Interventional Radiology","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140684331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose The aim of this study was to evaluate the safety and efficacy of using a trans-splenic approach for transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with portal vein thrombosis. (PVT). Materials and Methods A retrospective review was performed on 36 consecutive patients with PVT who underwent TIPS using a trans-splenic approach from February 2018 to June 2021. Preprocedural data including demographic information and Model for End-Stage Liver Disease (MELD) scores were obtained. Outcomes measured included technical success, clinical success, complications, and survival. Results Technical success was achieved in 32 of 36 patients (89%). During the follow-up period, 16 of 32 (50%) required secondary TIPS interventions, most of which were planned as part of a staged procedure. TIPS patency was 30/32 (94%) had stent patency on their most recent follow-up with a median follow-up of 164 days. No patients had variceal bleeding following TIPS. Eleven of thirty-two (34%) patients underwent successful transplant after TIPS. Anatomical portal vein end-to-end anastomosis was achieved in 11/12 (92%) patients. Conclusion The trans-splenic approach to TIPS is a reliable alternative to traditional TIPS in patients with PVT and provides high technical and clinical success rates. This technique can also be utilized to improve future liver transplant outcomes by facilitating anatomic portal vein end-to-end anastomoses.
{"title":"Trans-splenic Approach for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation in Patients with Portal Vein Thrombosis","authors":"M. Boumezrag, G. Lynskey, S. Sabri","doi":"10.1055/s-0044-1785526","DOIUrl":"https://doi.org/10.1055/s-0044-1785526","url":null,"abstract":"\u0000 Purpose The aim of this study was to evaluate the safety and efficacy of using a trans-splenic approach for transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with portal vein thrombosis. (PVT).\u0000 Materials and Methods A retrospective review was performed on 36 consecutive patients with PVT who underwent TIPS using a trans-splenic approach from February 2018 to June 2021. Preprocedural data including demographic information and Model for End-Stage Liver Disease (MELD) scores were obtained. Outcomes measured included technical success, clinical success, complications, and survival.\u0000 Results Technical success was achieved in 32 of 36 patients (89%). During the follow-up period, 16 of 32 (50%) required secondary TIPS interventions, most of which were planned as part of a staged procedure. TIPS patency was 30/32 (94%) had stent patency on their most recent follow-up with a median follow-up of 164 days. No patients had variceal bleeding following TIPS. Eleven of thirty-two (34%) patients underwent successful transplant after TIPS. Anatomical portal vein end-to-end anastomosis was achieved in 11/12 (92%) patients.\u0000 Conclusion The trans-splenic approach to TIPS is a reliable alternative to traditional TIPS in patients with PVT and provides high technical and clinical success rates. This technique can also be utilized to improve future liver transplant outcomes by facilitating anatomic portal vein end-to-end anastomoses.","PeriodicalId":507357,"journal":{"name":"The Arab Journal of Interventional Radiology","volume":" 40","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140682989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biswajit Sahoo, Satyapriya Mohanty, Siddhartha Sathia, R. Mahapatra, Manoj Kumar Nayak, Ritesh Panda, M. K. Panigrahi, S. K. Mishra, P. Sasmal, Pankaj Kumar, S. M. Ali, Nerbadyswari Deep (Bag), S. Majumdar, S. Barik, Sujata Devi, Arunprakash Pitchaimuthu
Objectives The aim of this study was to evaluate the safety and effectiveness of secondary interval AngioJet rheolytic thrombectomy after localized intra-arterial catheter-directed thrombolysis (CDT) through power-pulse spray (PPS) technique in partially successful or failed primary AngioJet rheolytic thrombectomy cases of acute and subacute peripheral artery thrombosis. Materials and Methods This retrospective study included 12 acute (< 2 weeks) and subacute (2–4 weeks) peripheral arterial thrombosis patients who underwent primary thrombectomy alone without CDT and patients who received secondary thrombectomy after CDT through PPS at our institute between May 2022 and December 2022. Technical success, procedure-related complications (local and systemic), amputations, and 1-year patency were evaluated. Results The angiographic success after primary thrombectomy was evaluated in 12 patients (9 acute and 3 subacute), and the results were categorized into three groups. Of 12 patients, complete success, partial success, and failure were noted in three (25%), five (41.7%), and four (33.3%) patients, respectively, after primary thrombectomy alone. Complete luminal patency was restored in all nine cases of partial success and failure in postprimary thrombectomy through adjunctive PPS thrombolysis and secondary thrombectomy. Technical and clinical success was achieved in all patients (100%). Transient hemoglobinuria was seen in five (41.7%) patients, and all had long-segment occlusion. At 1 year follow-up, no reocclusion, limb loss, or death was noted. Conclusion Complete success after primary thrombectomy was more likely in the setting of short-segment occlusion and small-caliber arteries. In patients with partial success or failure after the primary thrombectomy alone, secondary thrombectomy may be performed after the adjuvant PPS thrombolysis to achieve complete recanalization.
{"title":"Outcome of Secondary Interval Rheolytic Thrombectomy after Localized Intra-Arterial Catheter-Directed Thrombolysis through Power-Pulse Spray Technique in Cases of Partially Successful or Failed Primary Rheolytic Thrombectomy","authors":"Biswajit Sahoo, Satyapriya Mohanty, Siddhartha Sathia, R. Mahapatra, Manoj Kumar Nayak, Ritesh Panda, M. K. Panigrahi, S. K. Mishra, P. Sasmal, Pankaj Kumar, S. M. Ali, Nerbadyswari Deep (Bag), S. Majumdar, S. Barik, Sujata Devi, Arunprakash Pitchaimuthu","doi":"10.1055/s-0044-1782692","DOIUrl":"https://doi.org/10.1055/s-0044-1782692","url":null,"abstract":"\u0000 Objectives The aim of this study was to evaluate the safety and effectiveness of secondary interval AngioJet rheolytic thrombectomy after localized intra-arterial catheter-directed thrombolysis (CDT) through power-pulse spray (PPS) technique in partially successful or failed primary AngioJet rheolytic thrombectomy cases of acute and subacute peripheral artery thrombosis.\u0000 Materials and Methods This retrospective study included 12 acute (< 2 weeks) and subacute (2–4 weeks) peripheral arterial thrombosis patients who underwent primary thrombectomy alone without CDT and patients who received secondary thrombectomy after CDT through PPS at our institute between May 2022 and December 2022. Technical success, procedure-related complications (local and systemic), amputations, and 1-year patency were evaluated.\u0000 Results The angiographic success after primary thrombectomy was evaluated in 12 patients (9 acute and 3 subacute), and the results were categorized into three groups. Of 12 patients, complete success, partial success, and failure were noted in three (25%), five (41.7%), and four (33.3%) patients, respectively, after primary thrombectomy alone. Complete luminal patency was restored in all nine cases of partial success and failure in postprimary thrombectomy through adjunctive PPS thrombolysis and secondary thrombectomy. Technical and clinical success was achieved in all patients (100%). Transient hemoglobinuria was seen in five (41.7%) patients, and all had long-segment occlusion. At 1 year follow-up, no reocclusion, limb loss, or death was noted.\u0000 Conclusion Complete success after primary thrombectomy was more likely in the setting of short-segment occlusion and small-caliber arteries. In patients with partial success or failure after the primary thrombectomy alone, secondary thrombectomy may be performed after the adjuvant PPS thrombolysis to achieve complete recanalization.","PeriodicalId":507357,"journal":{"name":"The Arab Journal of Interventional Radiology","volume":" 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140683594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph Sumner, Sajal Patel, I. Theodoulou, N. Thulasidasan, P. Gkoutzios, Irfan Ahmed, Athanasios Saratzis, Athanasios Diamantopoulos
Objective The aim of this study was to report the primary outcomes of a pilot study investigating the safety and efficacy of sirolimus drug-coated balloons (SELUTION) for endovascular postatherectomy treatment of native occluded femoropopliteal lesions in patients with chronic limb-threatening ischemia (CLTI). Materials and Methods This study analyzes a cohort of CLTI patients with femoropopliteal artery occlusions treated with combined rotational atherectomy and postatherectomy angioplasty using the SELUTION device. The primary outcome measures were amputation-free survival (AFS) defined as time to major limb (above ankle) amputation of the index leg or death from any cause. Secondary outcome measures included technical success, overall survival, major amputation of the index leg, major adverse limb event (MALE) defined as major amputation or any further major revascularization intervention of the treated segment during the follow-up period and primary patency at 12 months. Results Between April 2021 and January 2022, nine patients (mean age: 64.0 ± 8.4, 66.7% male) with femoropopliteal occlusive lesions (mean lesion length: 141.1mm, range: 40–400) were treated with the above-combined approach. Technical success was 100%. At 12 months, the AFS was 88.9%, with one death and zero major amputations (88.9% survival and 100% limb salvage, respectively); only two patients (22.2%) suffered a MALE; primary patency was 75%. No adverse events related to the sirolimus drug-coated balloon nor to the atherectomy device were observed. Conclusion Combining sirolimus drug-coated balloon and atherectomy for treatment of femoropopliteal occlusions in CLTI patients is a safe and effective approach achieving satisfactory patency and adverse event rates.
{"title":"Combined Treatment of Native Femoropopliteal Occlusions in Chronic Limb-Threatening Ischemia Using Atherectomy Debulking and a New Sirolimus Drug-Coated Balloon (SELUTION SLR)","authors":"Joseph Sumner, Sajal Patel, I. Theodoulou, N. Thulasidasan, P. Gkoutzios, Irfan Ahmed, Athanasios Saratzis, Athanasios Diamantopoulos","doi":"10.1055/s-0044-1782664","DOIUrl":"https://doi.org/10.1055/s-0044-1782664","url":null,"abstract":"\u0000 Objective The aim of this study was to report the primary outcomes of a pilot study investigating the safety and efficacy of sirolimus drug-coated balloons (SELUTION) for endovascular postatherectomy treatment of native occluded femoropopliteal lesions in patients with chronic limb-threatening ischemia (CLTI).\u0000 Materials and Methods This study analyzes a cohort of CLTI patients with femoropopliteal artery occlusions treated with combined rotational atherectomy and postatherectomy angioplasty using the SELUTION device. The primary outcome measures were amputation-free survival (AFS) defined as time to major limb (above ankle) amputation of the index leg or death from any cause. Secondary outcome measures included technical success, overall survival, major amputation of the index leg, major adverse limb event (MALE) defined as major amputation or any further major revascularization intervention of the treated segment during the follow-up period and primary patency at 12 months.\u0000 Results Between April 2021 and January 2022, nine patients (mean age: 64.0 ± 8.4, 66.7% male) with femoropopliteal occlusive lesions (mean lesion length: 141.1mm, range: 40–400) were treated with the above-combined approach. Technical success was 100%. At 12 months, the AFS was 88.9%, with one death and zero major amputations (88.9% survival and 100% limb salvage, respectively); only two patients (22.2%) suffered a MALE; primary patency was 75%. No adverse events related to the sirolimus drug-coated balloon nor to the atherectomy device were observed.\u0000 Conclusion Combining sirolimus drug-coated balloon and atherectomy for treatment of femoropopliteal occlusions in CLTI patients is a safe and effective approach achieving satisfactory patency and adverse event rates.","PeriodicalId":507357,"journal":{"name":"The Arab Journal of Interventional Radiology","volume":" 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140684080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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