CardioVascular and Interventional Radiology最新文献

Purpose: To compare ultrasound-guided cryoablation (BCA) and breast-conserving surgery (BCS) for patients with early-stage, low-risk breast cancer using a cost-effectiveness analysis.

Materials and methods: A Markov decision tree was constructed comparing BCA and BCS for unifocal small (≤ 1.5 cm), lymph node-negative, ultrasound-visible breast cancer from a payer's perspective over a 5-year horizon. Clinical outcomes after cryoablation were based on the ICE3 trial, and those after BCS were based on a meta-analysis of 17 trials. Outcomes were measured in US dollars and quality-adjusted life years (QALY). Base case calculation, probabilistic and deterministic sensitivity analyses were performed.

Results: Base case analysis showed BCA achieved comparable health outcomes (0.01-0.09 QALY higher) at a lower cost (at least $17,682 of cost saving per patient). Probabilistic sensitivity analysis showed cryoablation to be the better strategy in majority of the iterations driven by its lower procedural cost. BCS became the better strategy when the annual mortality after BCA was > 2.1%, equivalent to a 5-year cancer survival after BCA < 90.0%. BCA was the more optimal strategy when its annual local recurrence risk was < 51.5% or distant recurrence risk was < 1.04%. BCS became the more cost-effective strategy if the cost of BCA was $20,906 more than BCS. BCA remained more cost-effective when accounting for follow-up, provided the difference in costs between BCA and BCS was less than $4000 annually.

Conclusion: BCA is a cost-effective strategy for patients with early-stage, low-risk, sonographically visible breast cancer when compared to BCS.

Background: Interventional radiology provides effective and minimally invasive means of treating a broad variety of emergency conditions such as bleeding, ischaemia or sepsis. Availability of 24/7 emergency interventional radiology care is an important prerequisite for optimal patient care. It is often lifesaving with generally low complication rates and excellent outcomes; however, safe and sustainable provision of interventional radiology care on a 24/7 basis requires efficient organisation and adequate infrastructure.

Purpose: This document will define the minimum structural and organisational standards required for the safe and sustainable delivery of emergency interventional radiology care on a 24/7 basis, depending on the spectrum of emergencies intended to be treated. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the provision of care.

Methods: The writing group was established by the CIRSE Standards of Practice Committee and consisted of eight clinicians with internationally recognised expertise in emergency interventional radiology. The writing group reviewed the existing literature on emergency interventional radiology, performing a pragmatic evidence search using PubMed to search for publications in English and relating to human subjects preferably published from 2010 to 2025. The final recommendations were formulated through consensus.

Results: Interventional radiology has a well-established role in the successful management of a broad variety of emergency conditions. This Standards of Practice document provides up-to-date recommendations for the safe and sustainable delivery of 24/7 emergency interventional radiology care.

Purpose: This review explores the clinical utility of spectral CT in interventional radiology (IR), including applications in pre-procedural planning, intra-procedural guidance, and post-procedural evaluation.

Methods: A narrative review was conducted exploring the use of spectral CT in IR, examining its applications across the clinical workflow.

Results: Spectral CT demonstrates strong potential to enhance diagnostic precision and procedural safety in IR practice.

Conclusion: Spectral computed tomography (CT) is an emerging imaging modality that offers numerous benefits including enhanced tissue characterization, improved lesion detection, and artifact reduction compared to conventional CT. Future implications of this modality include integration of artificial intelligence, photon-counting technology, and integration into clinical workflows.

Purpose: To evaluate arteriovenous fistula maturation and 12-month patency in patients undergoing oversized balloon angioplasty with high-pressure balloons alone or with high-pressure balloons plus drug-coated balloons as part of endovascular treatment for arteriovenous fistula maturation failure.

Material and methods: This prospective, non-randomized study was conducted between 2022 and 2024 at four centers in Brazil. Patients with primary arteriovenous fistula failure underwent oversized balloon angioplasty with high-pressure balloons alone or with high-pressure balloons + drug-coated balloons. Vascular access primary and secondary patency rates were evaluated at 3, 6, and 12 months in 198 patients. The safety endpoint was the incidence of procedure-related complications. Exploratory analyses included the impact of demographic and clinical variables on primary patency rates.

Results: Technical success was achieved in 99% of patients (196/198). At 12 months, vascular access primary patency was 57.8% for high-pressure balloons + drug-coated balloons vs. 41.3% for high-pressure balloons alone (p = 0.011). Twelve-month vascular access secondary patency rates were similar between groups (88.5% for high-pressure balloons + drug-coated balloons vs. 87.0% for high-pressure balloons alone, p = 0.69). Cox regression analysis identified oversized balloon angioplasty with drug-coated balloons and male sex as protective factors, reducing the 12 month risk of primary patency loss. In contrast, brachiocephalic arteriovenous fistulas and initial thrombosis were associated with an increased risk of patency loss.

Conclusion: Oversized balloon angioplasty with drug-coated balloons improved primary patency compared to high-pressure balloons alone.