CardioVascular and Interventional Radiology最新文献

Purpose: To evaluate the technical and clinical success, as well as the safety, of single-operator, single-session percutaneous cholangioscopy for the management of biliary stone disease.

Materials and methods: Thirty-four non-surgical patients (median age 69 years; 14 female, 20 male) from two tertiary care hospitals underwent 37 percutaneous cholangioscopy-guided stone extraction procedures between March 2023 and August 2025. Patient characteristics, procedural details, technical and clinical success, and complications were retrospectively reviewed.

Results: Twenty-six patients underwent percutaneous cholecystostomy (PC) and eight underwent percutaneous transhepatic biliary drainage (PTBD) prior to cholangioscopy. Primary technical success was 91.2% (31/34; 95% CI, 76.3-98.1)-88.5% in the PC cohort (23/26) and 100% in the PTBD cohort (8/8). After three repeat procedures, secondary technical success reached 100%. Clinical success, defined as the absence of recurrent cholecystitis or biliary colic, was achieved in 91.2% of patients over a median follow-up of 413 days. The median drain dwell time was 113 days, with a median interval of 14 days from stone extraction to drain removal. Two procedure-related complications occurred-one cystic duct injury and one pleural effusion (CIRSE classification 1a and 3b, respectively)-along with one non-procedure-related complication of prolonged delirium (CIRSE classification 3b).

Conclusion: Single-session percutaneous cholangioscopy-guided biliary stone management demonstrates high technical and clinical success with minimal complications and appears to be a viable treatment option for high-risk patients who are not candidates for surgery or peroral endoscopic interventions.

Purpose: Drug-coated balloon (DCB) angioplasty is a promising therapy for arteriovenous fistula (AVF) stenosis in hemodialysis patients. However, comparative evidence on the long-term efficacy of DCB versus plain balloon angioplasty (PBA), the sources of heterogeneity, and its differential effects on various access types remains inconclusive. This meta-analysis synthesizes randomized controlled trial (RCT) data to evaluate clinical outcomes of these approaches.

Materials: This meta-analysis of randomized controlled trials (RCTs) evaluated DCB versus PBA for AVF stenosis (PROSPERO CRD420250651907). We systematically searched PubMed, Embase, and Web of Science from inception to February 17, 2025, for RCTs reporting 6-month target lesion primary patency.

Results: Twenty-one RCTs (n = 2,537 patients) were included. DCB significantly improved primary patency at 6 months (OR 2.43, 95% CI: 1.81-3.27; P = 0.002) and 12 months (OR 1.88, 95% CI: 1.54-2.30; P = 0.230), but the benefit attenuated at 24 months (OR 1.36, 95% CI: 1.00-1.85; P = 0.794). Complication and mortality rates were comparable between groups at all timepoints.

Conclusions: DCB angioplasty provides superior short-to-medium-term primary patency versus PBA for AVF stenosis, although this benefit diminishes with prolonged follow-up. The two modalities show comparable safety. The higher initial cost of DCB necessitates individualized treatment decisions based on patient life expectancy and lesion characteristics.

Purpose: Microarteriovenous fistulas (m-AVFs) have been proposed as a potential cause of lower limb ulcers that are refractory to standard therapies. This study evaluated the feasibility and safety of transcatheter arterial embolization (TAE) using imipenem/cilastatin sodium (IPM/CS) in patients with m-AVF-related refractory skin ulcers.

Methods: This retrospective study included 17 patients with lower limb refractory skin ulcers treated with TAE from 2013 to 2023. M-AVFs were diagnosed via Doppler and confirmed by angiography. Embolizations were done under local anesthesia through femoral artery access, using imipenem/cilastatin mixed with contrast, injected until flow stagnation or a 0.5 g max. Technical success was defined as the elimination of early venous shunting on angiography. Clinical success was defined as a ≥ 50% reduction in ulcer size. Repeated TAE procedures were performed at 1-2-month intervals when clinical improvement was deemed insufficient, primarily based on physician judgment regarding ulcer size and pain. While no strict quantitative threshold was used, the decision to proceed with additional sessions beyond three was based on discussion between the patient and physician. The outcome evaluation included assessments of ulceration and pain severity.

Results: We performed 41 embolizations on 17 patients, with repeat sessions every 1-2 months if needed. Technical success was achieved in all cases (100%). No major complications occurred; minor pain was reported in ~ 20% of cases. Over an average 11.5-month follow-up, clinical success was observed in 88% of patients.

Conclusion: TAE with IPM/CS is a feasible and safe treatment option for refractory lower limb skin ulcers caused by m-AVFs.

Purpose: Accurate preprocedural imaging is crucial for optimizing percutaneous thermal ablation of hepatocellular carcinoma (HCC) thermal ablation. However, some nodules may remain undetected using conventional contrast-enhanced CT (CECT) and MRI (CEMRI), due to poor conspicuity. CT hepatic arteriography (CTHA) is an imaging technique that improves the detection of primary/secondary liver tumors. We aimed to assess the diagnostic performance of CTHA in detecting occult HCC nodules in cirrhotic patients undergoing percutaneous microwave ablation and to evaluate its impact on pretreatment planning.

Materials and methods: This retrospective, single-center study analyzed 38 CTHA-guided ablation procedures performed in 35 cirrhotic patients with confirmed HCC, from November 1, 2022, to December 31, 2024. All patients underwent preprocedural CECT /CEMRI within eight weeks before ablation. The number of additional nodules detected by CTHA and their suitability for immediate ablation were assessed.

Results: CTHA identified seven occult HCCs in 6/38 procedures (15.8%). The mean size of newly detected lesions was 13 mm (IQR 9). All additionally detected nodules were ablated during the same sessions. In 4/38 CTHAs (10.5%), vascular variants precluding a whole liver opacification were encountered. Technical success was achieved in 93.1% of all procedures, with a low rate of grade 1-3 complications (18.4%) and no severe ones. Eight treatments (21.6%) were followed by disease progression apart from the ablation zone.

Conclusion: CTHA enhances occult HCC detection, enabling immediate ablation and potentially improving outcomes. However, unusual vascular anatomy may hinder a comprehensive liver evaluation.

Background: To evaluate predictors of outcomes in colorectal liver metastases (CLM) patients undergoing 90Y radioembolization (TARE), focusing on the impact of tumor absorbed dose.

Materials and methods: Patients' characteristics and dosimetry assessments were analyzed in 231 patients undergoing 329 TARE sessions from 09/2009 to 07/2023. Response was assessed using RECIST1.1 and PERCIST criteria.

Results: Patients were predominantly male (137/231, 56.3%), had bilobar metastases (157/231, 68%) and received more than 3 lines of chemotherapy (144, 62.3%). Median age was 61 years (range 24-93). Glass and resin microspheres were used in 181/329(55%) and 148/329(45%) sessions, respectively. Weighted tumor absorbed dose covering at least 90% tumor (WTD90) ≥ 120 Gy (p = 0.043) and prior ablation (p = 0.016) were independent predictors of improved overall survival (OS) in the cohort. More than 10 CLMs (p < 0.001) and prior exposure to intra-arterial mitomycin-C (p = 0.015) were associated with decreased OS. Left colon (SHR: 1.680, 95% CI 1.136-2.484, p = 0.009) and rectal primary location (SHR: 1.586, 95% CI 1.005-2.504, p = 0.048) negatively impacted target liver progression-free survival (TLPFS), while intention to irradiate liver dose covering at least 50% tumor (ITILD50) had a positive impact (SHR: 0.955, 95% CI 0.926-0.984, p = 0.003) for the entire cohort. SIR Grade C and D complications were 1.2% and 2.7%, respectively, without correlation to dosimetry.

Conclusion: WTD ≥ 120 Gy was an independent predictor for improved OS after TARE for CLM regardless of microsphere type. High number of CLMs negatively impacted OS, while intention to irradiate liver dose covering at least 50% of the tumor positively impacted TLPFS.

The CIRSE classification system was published in 2017 aiming to standardize the reporting of complications by avoiding subjective definitions and an excessive number of grades. The original system described 6 grades: Grade 1: complication could be solved within the same procedure, Grade 2: unplanned prolonged hospitalization < 48 h without an additional therapy, Grade 3: additional therapies needed or hospitalization > 48 h, but no sequelae, Grade 4: mild sequelae beyond hospitalization, Grade 5: severe sequelae requiring assistance in daily life, and Grade 6: death.Following initial evaluation through a validation process performed during the International Conference on Complications in Interventional Radiology (ICCIR 2023), a need to modify the system was identified, specifically to stratify grades 1 and 3 based on the degree of impact on the patient in terms of success or failure of the procedure (Grade 1) and on the duration of hospital stay (Grade 3). Thus, Grade 1 was subdivided into 1a and 1b: 1b describing situations when the complication was resolved within the same procedure, but the intended procedure was not completed and Grade 3 subdivided into 3a: Hospital stay > 48 h, but < 2 weeks and 3b > 2 weeks to depict the complications that resulted in the most time- and resource consuming hospitalizations. It remained the case that no permanent sequelae are observed in grade 3.This initial testing of the modified classification system in an international IR complication meeting showed high reliability and strong inter-observer agreement. The modified CIRSE system for classification of complications addresses the shortcomings of the original system while remaining easy to use with clear and objective parameters describing the clinical outcomes after a complication.

Purpose: To describe the technique and evaluate the safety and clinical efficacy of CT-guided thermal ablation for postoperative isolated bile leakage (IBL) in patients with disconnected bile ducts.

Materials and methods: This retrospective study included 14 patients with postoperative IBL following liver resection between 2016 and 2024. All patients underwent CT-guided radiofrequency ablation (RFA) as treatment for IBL. Technical success was defined as appropriate coverage of the leakage site on post-ablation CT. Clinical success was defined as cessation of IBL; time to leak cessation was recorded accordingly. Total percutaneous biloma drainage time and peri-/post-interventional complications were evaluated accordingly.

Results: Technical success was achieved in all ablation procedures with no major adverse events. Clinical success was observed in 93% (n = 13) of patients. One patient experienced recurrence of IBL within 30 days. Median total drainage time was 33.5 (IQR 20-62) days. The median time to leak cessation after RFA was 4.5 (IQR 4-6) days.

Conclusion: CT-guided thermal ablation appears to be an effective and safe treatment option for postoperative IBL, helping to reduce the duration of drainage therapy.