CardioVascular and Interventional Radiology最新文献

Purpose: To evaluate the safety, technique and clinical outcome of genicular artery embolization (GAE) using resorbable gelatin microspheres (RGM) in patients with knee osteoarthritis (OA) or persistent pain after total knee replacement (TKR).

Material and methods: In this prospective observational study, 45 patients with knee OA (Kellgren-Lawrence 1-4, n = 35) or post-TKR pain (n = 10) were included. GAE was performed using 100-300 µm RGM. Embolic volume and treated vessels were documented. Clinical outcome was evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Numeric Rating Scale (NRS) at baseline, 6 weeks, 3 and 6 months. Psychological comorbidities were screened using the Hospital Anxiety and Depression Scale (HADS). Adverse events were recorded.

Results: At 6 months, mean NRS improved by 35% and KOOS subscale pain by 55% (p < 0.001) with no significant differences between OA grades and post-TKR. A median of 3 (2-6) vessels were embolized with a mean total embolic volume of 6.5 mL (2.1-18.0 mL) per session. Patients with a HADS score ≥ 8 showed less improvements in the KOOS (up to 2.2 points less per HADS point increase; p < 0.05). Total embolic volume was significantly higher in advanced OA and post-TKR, averaging at 2.7 mL more per OA grade (p < 0.0001). No major complications were observed.  CONCLUSION: GAE using RGM in doses higher than 2 mL is safe and demonstrates short-term clinical efficacy across all OA grades and in post-TKR pain. Patients with severe OA and post-TKR pain received higher embolic volumes. A HADS score ≥ 8 is associated with reduced clinical benefit.

Purpose: To assess the rates of success, complications, and re-interventions of selective arterial embolisation of renal angiomyolipomas.

Materials and methods: A systematic review and meta-analysis was conducted, including studies reporting outcomes of selective arterial embolisation for renal angiomyolipomas. Pooled estimates were calculated for technical success, radiological success, clinical success, tumour shrinkage, re-embolisation rates, surgical re-intervention, and complication rates. Heterogeneity was assessed using I² statistics. Exploratory regression modelling was performed to assess factors associated with re-intervention.

Results: Thirteen studies comprising 478 patients and 542 AMLs were included. Technical success-successful delivery and occlusion of the embolic agent-was achieved in 86.2% of cases (95% CI 80-89.1%; I² = 36.1%). Radiological success, based on CT-assessed tumour shrinkage, was observed in 94% of cases (95% CI 91.2-97.3%; I² = 15.6%). Subgroup analysis revealed ethanol-alone embolisation achieved the highest shrinkage (95.8%) and the lowest re-intervention rate (3.4%). Pooled re-intervention (re-embolisation or surgery) was required in 19% of cases (95% CI 10-34%; I² = 85.9%). Minor complications occurred in 46% of procedures, predominantly post-embolisation syndrome (PES, 43%; 95% CI 35-53%; I² = 88.8%). Major complications, such as retroperitoneal bleeding, significant haematuria, abscesses, or prolonged hospital admission, were rare (pooled rate: 5.7%; 95% CI 3.9-8.2%), and the pooled rate for surgical re-intervention was 4% (95% CI 2-7%) with low heterogeneity (I² = 9.6%; p = 0.333).

Conclusion and contribution: Embolisation is a safe primary treatment option for renal angiomyolipomas with high technical and radiologic success, low major complications, and rates of surgical intervention. Embolic agent choice significantly impacted outcomes in this cohort.

Purpose: This study evaluates the technical success, diagnostic yield, and complication rates of image-guided percutaneous renal biopsies based on multicenter registry data from the German Society for Interventional Radiology and Minimally Invasive Therapy.

Materials and methods: This retrospective analysis included 5,235 renal biopsies at 176 centers in Germany, Austria, and Switzerland between 2018 and 2024. Technical success was defined as image-guided confirmed needle placement within the target lesion. Diagnostic yield is defined as proportion of procedures providing adequate samples for clinical diagnosis.

Results: CT was used for image guidance in 78.53% followed by ultrasound in 12.32%. Technical success was 98.38% and diagnostic yield 94.92%. Technical success was high in both inpatients (98.33%) and outpatients (99.26%; OR = 0.44, 95%CI 0.11-1,80; p = 0.241). The overall complication rate was 5.04%, with major complications in 0.74%. Complications were more frequent with pathological platelet counts and INR values, but none of these coagulation parameters remained independently associated in multivariable analysis. CT-guided biopsies showed higher complication rates than ultrasound-guided procedures, and this association remained after adjustment (adjusted OR 8.57, 95%CI 3.40-21.58; p < 0.001). No fatal complications occurred within 24 h; however, three delayed deaths were documented among hospitalized patients.

Conclusion: Percutaneous image-guided renal biopsies are effective and safe, with low complication rates and high diagnostic yield. Ultrasound guidance remained independently associated with a lower complication risk, likely reflecting selection bias.