CardioVascular and Interventional Radiology最新文献

Purpose: To describe the outcomes of a patient cohort following transcatheter embolisation for type 2 endoleaks associated with sac expansion.

Materials and methods: A retrospective single-centre observational study was performed between September 2005 and June 2023. Technical success rates and long-term outcomes were evaluated including technical factors associated with endoleak recurrence and rupture. One hundred transcatheter embolisations were performed for type 2 endoleaks in 72 patients (64 male and 8 female).

Results: Technical success (cessation of flow in the endoleak on angiography) was achieved in 77/100 (77%) procedures. Clinical success (freedom from sac growth on surveillance) was achieved in 82% at 12 months, 70% at 24 months and 59% at 60 months. Persistent endoleaks were found in 27%, with 7% developing a new type 2 and 14% developing new type 1, 3 or 5 endoleaks. The rupture rate was 7%, including 2/7 persistent type 2 endoleaks, 4/7 new type 1 or 3 endoleaks and 1/7 type 5 endoleak. Embolisation was performed either via a transarterial route (74%) or via direct sac puncture (24%), the latter demonstrating a significant correlation with technical success (p=0.018).

Conclusions: This study confirms the importance of embolisation as the main treatment modality of type 2 endoleaks with freedom from sac growth achieved in 70% of patients at 24 months. However, this remains a complex entity with persistent sac growth, risking the development of type 1 or 3 endoleaks, which carry a risk of late sac rupture.

Purpose: Approximately 1-7% of patients develop persistent lymphatic ascites after liver transplantation. This study describes the diagnosis and treatment of lymphatic ascites in patients post liver transplantation, refractory to conservative therapy.

Materials and methods: A review of the prospectively collected database was conducted to identify patients who received interventions for persistent lymphatic ascites following liver transplantation. Patient demographics, baseline characteristics, imaging findings, procedural details, and follow-up information were gathered.

Results: Four adult patients after orthotopic liver transplantation with chylous ascites (CA) and 4 pediatric patients after split liver transplantation with hepatic lymphorrhea (HL) were included in this study. CA patients were characterized by elevated triglycerides (1010 mg/dL, 442-1769), and HL patients were characterized by low serum albumin ascites gradient (SAAG < 1.1) and low triglycerides. In 3/4 patients with CA, dynamic contrast MR lymphangiography and intranodal lymphangiography demonstrated obstruction of the central lymphatic system. The mesenteric lymphatics were then embolized with either n-BCA glue or lipiodol. One-fourth patients had stenosis of the portal vein anastomosis, which was balloon dilated using a transjugular approach. All 4 patients reached resolution of ascites at a median of 27 days. In 3/4 patients presenting with HL, liver lymphangiography demonstrated extravasation of the contrast. That was embolized with either glue or lipiodol. One-fourth patient demonstrated no extravasation but significant lymphangiectasia. In all patients, there was a resolution of ascites at a median of 14 days after intervention.

Conclusion: Three mechanisms of post-transplantation lymphatic ascites were identified: portal venous hypertension due to iatrogenic obstruction; obstruction of central lymphatics resulting in congestion of the mesenteric lymphatic system and mesenteric lymphatic leak; and liver lymphorrhea. Identification of the mechanism of ascites allowed for successful percutaneous treatment in all patients.

Purpose: This study aims to characterize the practice of female interventional radiologists (IRs) from India and identify gender-related barriers. It provides insights and baseline data to guide initiatives advancing gender equity and diversity in the specialty.

Methods: A cross sectional study of female members of the Indian Society of Vascular and Interventional Radiology (ISVIR) was conducted between February and July 2025. Respondents provided demographic data and perspectives on leadership, work-life balance, gender bias, and career satisfaction. Descriptive analysis and logistic regression identified predictors of career outcomes.

Results: ISVIR registry listed 1,553 members, of whom 163 (10.5%) were women. Of the 95 eligible women, 86 completed the study (86/95, 90.5%). Most respondents (53/86, 61.6%) were in early career stages(0-5 years post-training). Dual practice in diagnostic radiology and IR was common (54/86, 62.8%). Leadership roles were limited (20/86, 23.3%), and 43% (37/86) perceived gender-related barriers. Mentorship was predominantly male (71/86, 82.6%). Gender inequities were reported in salary (22/86, 25.6%), procedural access (49/86, 57%), and patient perceptions (45/86,52.3%). About 55.8% (48/86) reported marital status negatively impacted their careers. Burnout was perceived by 75.6% (65/86) of participants. Early career participants were more likely to leave IR (p = 0.027; OR = 0.293; 95% CI: 0.099-0.870), while seniors reported gender-based discrimination (p = 0.024; OR = 2.625; 95% CI: 1.137-6.062). Despite these challenges, (74/86) 86% described IR as rewarding, and (77/86) 89.6% would choose IR again.

Conclusion: Women represent a minority of the IR workforce in India, with the majority being in training/early career. Mentorship, marital status, salary, procedural access, and patient perceptions were potential gender barriers.

Purpose: To compare the patency outcomes and safety profile between the modified TR Band and the PreludeSYNC DISTAL (PSD) for hemostasis following distal transradial access (dTRA) for transarterial chemoembolization (TACE).

Methods: This prospective randomized trial enrolled 104 participants undergoing TACE via dTRA (143 procedures, all performed using a 4-Fr catheter. Participants achieved hemostasis with either the modified TR Band (n = 74) or PSD (n = 69). The primary endpoint was the incidence of radial artery occlusion (RAO) assessed by Doppler ultrasonography at 4 h, 24 h, and > 1 week. Outcome assessors were blinded. Secondary endpoints included hemostatic performance and complications.

Results: No complete RAO occurred in either group (0/143). Partial RAO (mural thrombus with preserved flow) peaked at 4 h (TR Band: 28.4% vs. PSD: 18.8%; risk difference 9.5%, 95% CI -4.3 to 23.3%, p = 0.181) and declined to 4.1% vs. 2.9% by final follow-up (p = 1.000), representing a spontaneous resolution rate of 85.3%. Generalized estimating equations showed no significant difference in overall incidence. The TR Band group had a numerically higher rate of delayed hemostasis (> 4 h) compared with PSD (5.4% vs. 0.0%, p = 0.121). Complication rates (hematoma, pseudoaneurysm) did not differ significantly.

Conclusion: The modified TR Band and PSD demonstrated comparable rates of partial radial artery occlusion and access-site complications following dTRA for TACE.