CardioVascular and Interventional Radiology最新文献

Purpose: This scoping review presents an overview of available ablation confirmation (AC) software used during thermal ablation (TA) of liver tumours, focusing on features influencing clinical implementation.

Methods: A systematic search in PubMed, Embase, and Web of Science identified studies reporting on local tumour progression (LTP) following TA using AC software for quantitative assessment of minimal ablative margins (MAM). Clinical usability was evaluated by scoring presence of data on ten predefined software features that could enhance clinical adoption, per software.

Results: Of 491 articles, 23 studies on 18 AC software tools were included. Most AC software was commercially available (13/18; 72%), of which 31% were non-dedicated software to liver ablation margin assessment. Clinical usability parameters were frequently underreported, with an average score of 4 out of 10.

Conclusion: Although clinical availability and evidence for AC software-based margin assessment are increasing, factors enhancing clinical usability are relatively poorly studied, limiting current clinical integration.

Purpose: A simple and real-time method for the direct and precise identification of safety margins is needed in ultrasound (US)-guided radiofrequency ablation (RFA). Additionally, modulation of the post-ablation immunosuppressive microenvironment is required. The aim of this study was to develop an injectable, ultrasound-visible and immunoregulatory hydrogel for ultrasonic monitoring and adjuvant immune regulation in liver tumor ablation.

Methods: The experiment was performed in 2 steps. Step 1-The US visibility and stability of the markers were evaluated in vitro in bovine livers, followed by in vivo animal test in beagles. Step 2-Evaluation of the antitumoral effect after RFA of the specific US marker F127-MB@MSA-2, which has immunomodulating properties, in murine in vivo animal tumor models.

Results: In step 1, 24 candidate materials were tested for ultrasound visualization in bovine liver. Among these, air, 5 mm metal stick, Pluronic F127 hydrogel microbubbles (F127-MB), polyglycolic acid (PGA) absorbable sutures, ultrasonic couplant, and calcium alginate demonstrated clear ultrasonic visibility and enduring stability in vitro and in vivo. In step 2, the antitumoral effect of F127-MB@MSA-2 after incomplete RFA was demonstrated in murine H22 and CT26 tumor models. Tumor Flow cytometry and immunofluorescence staining revealed that F127-MB@MSA-2 gel reduced the infiltration of tumor-promoting cells, while it increased the proportion of CD8⁺ T cells within the tumors after RFA.

Conclusion: Using animal models, we demonstrated the feasibility of US-guided administration of the multifunctional gel (F127-MB@MSA-2) prior to RFA, which helped to accurately ablate tumors and increase the anti-tumor effect.

Purpose: To evaluate the efficacy and safety of balloon-only venous arterialization (BOVA) in patients with chronic limb-threatening ischemia (CLTI) and refractory ischemic ulcers after failed or no feasible conventional revascularization.

Materials and methods: This multicenter retrospective cohort study included 56 limbs treated with BOVA at five Japanese institutions between May 2021 and December 2023. The primary efficacy outcome was 12-month complete wound healing, and the primary safety outcomes were 12-month freedom from major amputation and overall survival.

Results: The cohort was high-risk: 76.8% had diabetes, 87.5% were on hemodialysis, 50.0% were Rutherford category 6, and 85.7% were Wound, Ischemia, and foot Infection stage 4. All pedal arteries were occluded in 80.4% of limbs. The 12-month complete wound healing rate was 45.5% (median time: 128 days). Freedom from major amputation, overall survival, and amputation-free survival were 83.5%, 54.6%, and 43.9%, respectively. Reintervention incidence was 5.58 procedures per person-year.

Conclusion: BOVA appears to be a feasible limb salvage strategy for patients with CLTI without conventional revascularization options.

Level of evidence: Level 3b.

Purpose: The incidence of renal cell carcinoma (RCC) has risen in recent decades, mainly due to the widespread use of diagnostic imaging. Percutaneous cryoablation (PCA) is minimally invasive, making it favorable if surgery is contraindicated. This study evaluates the oncological efficacy and safety of PCA as a treatment for T1b RCC.

Material and methods: This retrospective study included 35 patients with T1b RCC treated with PCA. Patients were included if they had at least 3 years of follow-up. Oncological outcomes were analyzed using descriptive statistics and Kaplan-Meier survival curves. Furthermore, estimated glomerular filtration rate (eGFR) changes were described, and postoperative complications were graded according to the Clavien-Dindo classification.

Results: The primary efficacy rate was 68.6%, with a median follow-up time of 34.7 months (range: 0-66.5 months), and the secondary efficacy rate was 77.1%, with a mean follow-up time of 41.6 months (range: 0-66.5 months). After primary PCA, 17.1% (n = 6) were incomplete. Local tumor progression was found in 14.3% (n = 5) of patients. The disease-free survival rates at 1, 3, and 5 years were 80.0%, 69.3%, and 60.0%, respectively. Four patients (11.4%) progressed from localized RCC to metastatic disease. The average decline in eGFR was 6.7 mL/min/1.73 m² 1 year after PCA. Complications were observed in 11.4% (n = 4) of patients.

Conclusion: This study found that treating T1b RCC with PCA was challenging. Local tumor control rates were low, and the risk for metastatic progression was high. However, PCA demonstrated a commendable safety profile, with few complications and good preservation of kidney function.

Level of evidence: 3, a retrospective cohort study.