CVIR Endovascular最新文献

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.

Background: Benign prostatic hyperplasia (BPH) is the most common urological disorder in older males, often treated with prostate artery embolization (PAE) to alleviate lower urinary tract symptoms. While traditional embolic materials like microspheres are common, issues such as symptom recurrence and non-target embolization remain. This systematic review evaluates the safety and effectiveness of n-butyl cyanoacrylate (NBCA) glue as an alternative embolic agent for PAE.

Materials and methods: A thorough search was performed across databases including PubMed, ScienceDirect, Cochrane, Google Scholar, Scopus, and MEDLINE. Studies were included if they assessed NBCA glue for PAE in BPH patients. Exclusions were made for reviews, non-English articles, conference abstracts, and studies not using glue or ethiodized oil mixtures. The Methodological Index for Non-Randomized Studies criteria was used to assess bias risk, and due to varied outcome measures, a narrative synthesis was conducted.

Results: Six studies involving 667 patients met the inclusion criteria. The age in mean ± SD across studies ranged from 67.5 ± 7.8 to 72.6 ± 10.5 with most patients presenting with moderate to severe BPH unresponsive to medication. NBCA glue-based procedures showed high technical success rates and shorter procedure times. International Prostate Symptom Score improvement was reported in 83-94% of patients across all studies with associated quality of life significantly enhanced in up to 94% of patients as well. Prostate volume reduction ranged from 11% to 40.5%, depending on follow-up duration. PSA levels and medication use decreased, and erectile function was mostly preserved, though results varied. Minor complications like groin hematomas and post-embolization syndrome occurred in 4-22% of patients, with no major adverse events reported.

Conclusion: This review assesses NBCA-based glue as a potential embolic agent in PAE for BPH. The evidence suggests promising short-term outcomes with a favorable safety profile, though findings remain preliminary due to small sample sizes and short follow-up. Larger multicenter randomized trials are therefore needed to validate these results and guide clinical practice.

Background: To systematically scope the clinical integration of artificial intelligence (AI) in diagnostic and interventional radiology. This integration encompasses various components of AI forms such as deep learning, convolutional neural networks, natural language processing, and machine learning.

Methodology: A Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) was employed to evaluate current primary and translation literature on the utility of AI in diagnostic and interventional radiology in broad disease categories.

Results: Following the review for inclusion criteria, a total of 23 peer-reviewed research articles were selected for review. Notably, most studies were found to focus on diagnostic and interventional radiology and oncologic diseases, including lung, hepatocellular, colorectal, prostate, pancreatic, breast, and blood cancers.

Conclusions: Radiologists have an advantageous role with the integration of these tools in clinical practice. This may include disease prediction models, catheter navigation, and image reconstruction. Utilization of these AI tools can help improve and further expose of the capabilities of diagnostic and interventional radiology to patients worldwide. From a disease standpoint, this review found most of the clinical literature has implemented AI tools for diagnostic and interventional radiology in oncology, followed by vascular diseases. Careful navigation is necessary to address the current logistical challenges, educational demands, and ethical dilemmas to ensure the safe and effective incorporation of these technologies into clinical radiologic settings.

Purpose: To discuss endovascular techniques and report the outcomes for endovascular treatment of true renal arterial aneurysms (TRAAs).

Materials and methods: A 22-year retrospective analysis of endovascular treatment of TRAAs in our institution. Aneurysm characteristics and endovascular techniques are discussed. Outcome measures were technical and clinical success (need for reintervention), renal parenchymal perfusion loss, impact on renal function, and complications. A 30-day mortality analysis was performed. Impact on renal function was assessed with a two-tailed, paired t-test of pre- and post-procedural serum creatinine.

Results: Eighteen endovascular procedures were performed to treat 15 TRAAs in 14 patients (including three reinterventions). 14/15 TRAAs were classified as Type 2 and 1/15 as Type 1 (Rundback classification). Mean initial aneurysm size was 22.9 mm (range 5-40 mm). Of the 14 Type 2 TRAAs, five were initially treated with balloon-assisted Onyx embolisation, four with stent-assisted coiling, four with sac packing, and one with stent-grafting. The technical success rate was 100%. The TRAAs requiring reintervention had been originally treated with balloon-assisted Onyx embolisation (two TRAAs) and stent-grafting (one TRAA). Renal parenchymal loss was < 10% in 10/15 TRAAs after initial intervention. At reintervention, 2/3 cases had 60-70% estimated parenchymal loss as the TRAAs had to be treated more aggressively. Complications (grade 1-3) occurred in 5/18 procedures. The grade 2 complication was atrophy and loss of renal function of the treated kidney (with serum creatinine remaining in the normal range) (n = 1). Grade 3 complications were brachial access pseudoaneurysm (n = 1), common femoral vein thrombosis (n = 1), and access site cellulitis (n = 1).

Conclusion: Endovascular treatment of TRAAs has a high rate of technical success and a low impact on renal function. A higher rate of reintervention was observed for TRAAs treated with Onyx embolisation, leading to a shift towards stent-assisted coiling as our preferred technique when anatomically feasible.