CVIR Endovascular最新文献

Purpose: To evaluate the safety and effectiveness of microfibrillar collagen paste (MCP), coils, and coils combined with gelatin sponge for transhepatic access tract embolization following portal vein islet cell transplant.

Methods: A retrospective review was conducted at a single institution between January 2008 and October 2024, including 20, 28, and 21 consecutive islet cell transplant procedures requiring transhepatic access embolization with MCP, coils, and coil plus gelatin sponge, respectively. All procedures were performed via a right portal vein branch. MCP was performed using Avitene (BD). The average number of coils required in the coil plus gelatin sponge and coil-only groups were 1.8 and 1.6 coils per procedure, respectively. All patients were placed on therapeutic anticoagulation during the procedure and for at least two weeks post-transplant. Medical records were reviewed to compare laboratory results, portal venous pressures, post-procedure liver ultrasounds, and 30-day hemorrhagic events across the three groups.

Results: All procedures were technically successful. However, one instance of coil migration into a portal vein branch occurred in the coil plus gelatin sponge group (1/28, 3.5%). Baseline hemoglobin, platelet counts, and partial thromboplastin time did not differ significantly between groups (p > 0.05). A statistically significant lower international normalized ratio (INR) was observed in the MCP group compared to the gelatin sponge and coil-only groups (1.0 vs. 1.1 vs. 1.1, p = 0.0036 and 0.004). No statistically significant differences were found in hemoglobin changes, post-transplant portal venous pressures, or post-embolization hemorrhagic events (p > 0.05). One patient in the coil plus gelatin sponge group developed a large subcapsular hematoma (1/27, 3.7%), while another in the MCP group experienced a large right hemothorax (1/20, 5.0%).

Conclusion: MCP, coils, and coil plus gelatin sponge are similarly effective for transhepatic access closure following islet cell transplant in anticoagulated patients. However, coil embolization may require multiple coils and carries a risk of migration.

Introduction: The field of interventional radiology (IR) has witnessed rapid advancements, with an increasing emphasis on complex and high-risk procedures. Increasingly, new IR treatments are becoming both available and indicated for patients with complex comorbidities. As a result, anaesthetic expertise has become essential to ensure patient safety, optimise procedural outcomes, and manage perioperative complications. Despite this growing demand, dedicated anaesthetic teams in IR remain limited, which leads to concerns regarding patient safety and procedural efficiency.

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, and the Cochrane Library, to identify studies published up to September 2024 that examined the expanding scope of IR, with a focus on the increasing need for anaesthetic support. This commentary draws on the existing literature to discuss the interaction between anaesthesia and interventional radiology, with particular attention to procedural sedation, pain management, and the care of high-risk patients. This commentary also evaluates workforce limitations, logistical challenges, and potential benefits of increased anaesthetic involvement in IR.

Findings: Existing literature demonstrates the significant benefits of anaesthetic involvement in IR. The presence of an anaesthesiologist was associated with reduced procedural risks, enhanced patient satisfaction, and quicker postoperative recovery times. Despite these benefits, many IR departments remain under-resourced in terms of dedicated anaesthetic staff. Furthermore, training programmes for anaesthesiologists rarely focus on the unique demands of IR, creating a gap in specialist care. The growing complexity and risk associated with IR procedures underscore the need for expanded anaesthetic support in this field. Hospitals and healthcare systems should prioritise the integration of anaesthetic teams into IR, investing in specialist training and workforce expansion. Doing so can improve patient outcomes and the overall efficiency of IR procedures, reducing procedural risks, increasing patient satisfaction, and facilitating quicker postoperative recovery times.

Background: Femoropopliteal diffuse calcified occlusions (FPDCOs) are challenging, especially in high-bleeding-risk patients for whom a stentless strategy is preferred. We introduce FRAP-CROSS, combining Fracking and Rendezvous-PIERCE, to achieve intracalcium guidewire crossing and facilitate stentless revascularization.

Materials and methods: When bidirectional intracalcium wiring fails across dense calcification in FPDCO, FRAP-CROSS is applied. Fracking is initially performed by inserting a 20-gauge metal needle into a guidewire-uncrossable plaque and applying hydraulic pressure to create microfractures, facilitating subsequent guidewire crossing. If device tracking remains unsuccessful after guidewire passage, Rendezvous-PIERCE is employed. An 18-gauge needle is advanced toward the intralesional guidewire tip, and the guidewire is externalized through the needle (Needle Rendezvous). A 20-gauge needle is then advanced over the externalized guidewire to create a lumen within the calcification (inner PIERCE). After successful all-intracalcium crossing, balloon angioplasty is performed. Inadequate expansion prompts additional Fracking alone or with Jetstream atherectomy (JET-Frack). Drug-coated balloon (DCB) angioplasty completes the stentless strategy.

Results: A 90-year-old man at high bleeding risk with bilateral FPDCOs underwent FRAP-CROSS. The right limb required three Fracking and two Rendezvous-PIERCE; the left required four Fracking and two Rendezvous-PIERCE, respectively, with adjunctive JET-Frack. Following DCB-based stentless treatment, final angiography and intravascular ultrasound confirmed adequate luminal expansion and blood flow in both limbs, without major complications.

Conclusion: FRAP-CROSS provides a practical approach to achieve all-intracalcium guidewire crossing and stentless revascularization in complex FPDCOs. Further studies should assess its safety and long-term outcomes.

Background: To assess how patients interpret and adhere to the International HHT Guidelines' recommendation to avoid intravenous (IV) air and to evaluate whether misinterpretation of this guidance as a strict requirement for in-line bubble filters may inadvertently hinder access to care. An anonymous 15-question survey was distributed to 7000 members of the HHT Research Network. The survey assessed awareness of the guideline, perceived necessity of bubble filter use, and the practical consequences of filter use. Responses were excluded if incomplete or submitted by individuals under 18 years old.

Results: Of the 596 responses received (9% response rate), 446 met inclusion criteria. Most respondents (79%) were aware of the guideline, and 66% interpreted it as requiring use of an IV bubble filter. Notably, 16% of respondents reported refusing care, and 25% reported delaying treatment-most often patient-initiated-due to perceived filter requirements. The interventions affected included essential and, in some cases, urgent care. In total, 20 respondents (4%) reported experiencing a transient ischemic attack (TIA) during IV therapy; two of these occurred despite filter use, and none resulted in permanent deficits. Patients who did not use filters were significantly less likely to report difficulty accessing care (p < 0.05).

Conclusions: Although the guideline advises caution in avoiding IV air, many patients interpret it as mandating bubble filter use. This misunderstanding has been linked to delays in necessary care, increased patient frustration, and limited treatment access. These findings underscore the importance of clearer communication and education around guideline intent to mitigate unintended consequences.

Background: Parastomal varices are a rare but serious complication in patients with portal hypertension, characterised by bleeding that can be life-threatening in a predominantly comorbid population. Traditional surgical approaches to managing parastomal varices are associated with high morbidity and recurrence rates, prompting increased interest in minimally invasive techniques. This systematic review aims to evaluate the efficacy and safety of interventional radiology (IR) procedures, including transjugular intrahepatic portosystemic shunt (TIPS), sclerotherapy and embolisation, in managing parastomal varices.

Methods: A comprehensive literature search was conducted across multiple databases, including MEDLINE, EMBASE and Web of Science, to identify studies published up to January 2025 that reported IR interventions for parastomal varices. Data were extracted on patient demographics, procedural success, recurrence rates and complications. A pooled proportions meta-analysis was performed.

Results: Five studies, encompassing 45 patients, met the inclusion criteria. The pooled technical success rate of IR procedures was 91.3%, with a clinical success rate of 80.5% over a mean follow-up of 618.4 days. The pooled mean proportion of rebleeding, predominantly minor and non-life-threatening, was 36.4%. TIPS showed the highest efficacy, but is traditionally associated with increased procedural risks compared to other interventional radiology methods.

Conclusion: IR offers a highly effective and safe alternative to traditional surgical management for parastomal varices in contemporary terms. The low recurrence and complication rates highlight the potential of IR ab initio as a first-line treatment; consequently, we advocate for its use, particularly in patients unsuitable for surgery in the minimally invasive era.

Systematic review registration: PROSPERO CRD42024627470.

Background: Hepatic artery pseudoaneurysms (HAP) and hepatic haemangiomas (HH) may present with indistinguishable imaging characteristics, particularly when clinical history favors one diagnosis over the other. Primary imaging alone may be insufficient for definitive differentiation. This case highlights the importance of further non-invasive imaging modalities in avoiding unnecessary invasive procedures if clinical condition allows.

Case presentation: A 55-year-old patient presented with abdominal trauma after a fall. Computed tomography (CT) revealed a grade III liver laceration with a hyper vascular lesion near the right hepatic artery, initially suspected to be a HAP. Trans-arterial embolization (TAE) was planned, and selective catheterization was performed. However, angiography showed no pseudoaneurysm filling but rather features suggestive of a haemangioma, leading to the abortion of the procedure. Subsequent magnetic resonance imaging (MRI) confirmed a flash-filling HH. The patient remained stable, with no haemorrhagic complications or need for further intervention.

Conclusion: In emergencies, recognizing imaging features distinguishing haemangiomas from pseudoaneurysms is crucial to avoid unnecessary invasive procedures, especially in stable patients, using accurate non-invasive tools like CT or MRI.

Background: There have been several analyses conducted demonstrating a sharp decrease in general physician fulfillment and satisfaction. Other studies have demonstrated that burnout, anxiety, and moral injury are prevalent among interventional radiologists specifically, however there is a paucity of literature examining professional fulfillment within the profession. The purpose of this study was to characterize professional fulfillment through job, career, and specialty satisfaction scores among interventional radiologists using a validated assessment tool.

Results: There were 106 respondents included in the analysis: 97 (91.5%) practicing interventional radiologists and 9 (8.5%) interventional radiology trainees, including 87 (82.1%) males and 19 (17.9%) females. Respondents included those in academic (40; 37.7%), private practice (46; 43.4%), and hybrid/other settings (20; 18.9%), as well as at various lengths of practice. The mean job satisfaction score was 3.48, with 38 (35.8%) of respondents expressing a mean score of ≥ 4, which has been established as being "satisfied". The mean career satisfaction score was 3.40, with 38 (35.8%) of respondents reporting a mean score of ≥ 4. The mean global specialty satisfaction was 3.63 with 53 (50.0%) of respondents reporting a mean score of ≥ 4.

Conclusions: Professional fulfillment is low among interventional radiologists, with half expressing global specialty satisfaction and with minority percentages signaling job and career satisfaction. Patient interaction and work-life balance were identified as significant factors positively affecting professional fulfillment.