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1.
Hussein D. Aoun Peter J. Littrup Mohamed Jaber Fatima Memon Barbara Adam Mark Krycia Matthew Prus Elisabeth Heath Edson Pontes 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1363-1370
Purpose
To retrospectively assess long-term outcomes of percutaneous renal cryoablation, including factors affecting complications and local recurrence rates.Materials and Methods
A total of 357 computed tomographic (CT) fluoroscopy–guided percutaneous cryoablation procedures were performed for 382 masses in 302 outpatients; 347 were biopsy-proven renal-cell carcinoma (RCC) or Bosniak category > III masses (n = 28). Benign pathologic conditions (n = 18) or metastatic non-RCC disease (n = 17) were included to analyze procedural complication rate, but recurrence rates, tumor staging, and nephrometry score were limited to RCCs. The average tumor diameter was 2.9 cm (range, 1–10.3 cm), and median nephrometry score for RCC was 8 (mean, 7.4). Protection of adjacent vital structures was performed in 34% of procedures (n = 121), and ureteral stent placement was performed for 9.2% (n = 33). All major complications were graded per surgical Clavien–Dindo criteria.Results
The average CT-visible cryoablation zone diameter was 5 cm (range, 2.5–10.5 cm). Grade ≥ 3 complications occurred in 2.8% of procedures (n = 10), and appeared related to only high nephrometry scores (P = .0086) and larger tumors (P = .0034). No significant changes in renal function before and after the procedure were noted (P = .18). At a mean follow-up of 31.8 months, the local tumor recurrence rate was 3.2% (11 of 347) for RCC, and no significant difference was noted between tumors larger or smaller than 3 cm (P = .15). The difference reached significance only among the small number of stage ≥ T2 RCC tumors (P = .0039).Conclusions
Long-term follow-up of percutaneous renal cryoablation demonstrates low recurrence rates with preserved renal function, even for patients with high nephrometry scores and body mass index, assuming thorough cytotoxic technique and protection measures. 相似文献2.
Shivank Bhatia Sardis H. Harward Vishal K. Sinha Govindarajan Narayanan 《Journal of vascular and interventional radiology : JVIR》2017,28(6):898-905
Purpose
To compare safety and feasibility of prostate artery embolization (PAE) via transradial/transulnar access (TR/UA) and transfemoral access (TFA).Materials and Methods
A retrospective analysis was conducted for 3 cohorts: the first 32 consecutive PAE procedures performed via TFA (initial TFA, January 2014 to August 2015), the following 32 procedures performed via TFA (advanced TFA, August 2015 to February 2016), and the first 32 procedures performed via TR/UA (February 2016 to July 2016). Indications included lower urinary tract symptoms (n = 68), urinary retention (n = 24), and preoperative embolization before prostatectomy (n = 4). A single operator performed all procedures at a single institution.Results
Technical success was achieved in 29/32 (90.6%) initial TFA procedures, 31/32 (96.9%) advanced TFA procedures, and 30/32 (93.8%) TR/UA procedures. Mean procedure time was 110.0 minutes in TR/UA group, 155.1 min in initial TFA group, and 131.3 minutes in advanced TFA group (P < .01 and P = .03 relative to TR/UA); mean fluoroscopy time was 38.8 minutes in TR/UA group, 56.5 minutes in initial TFA group, and 48.0 minutes in advanced TFA group (P < .01 and P = .02 relative to TR/UA). Access site–related and overall adverse events did not vary significantly among study cohorts (P > .15 and P > .05, respectively).Conclusions
TR/UA represents a safe and feasible approach to PAE with a comparable safety profile to TFA. Reduced procedure and fluoroscopy times might be attributable to the learning curve or method of arterial access. 相似文献3.
Eric J. Hohenwalter James R. Stone Paul V. O’Moore Steven J. Smith J. Bayne Selby Robert J. Lewandowski Shaun Samuels Paul M. Kiproff David W. Trost David C. Madoff Jeremy Handel Eric J. Gandras Athanasios Vlahos William S. Rilling 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1353-1362
Purpose
To demonstrate rates of successful filter conversion and 6-month major device-related adverse events in subjects with converted caval filters.Materials and Methods
An investigational device exemption multicenter, prospective, single-arm study was performed at 11 sites enrolling 149 patients. The VenaTech Convertible Vena Cava Filter (B. Braun Interventional Systems, Inc, Bethlehem, Pennsylvania) was implanted in 149 patients with venous thromboembolism and contraindication to or failure of anticoagulation (n = 119), with high-risk trauma (n = 14), and for surgical prophylaxis (n = 16). When the patient was no longer at risk for pulmonary embolism as determined by clinical assessment, an attempt at filter conversion was made. Follow-up of converted patients (n = 93) was conducted at 30 days, 3 months, and 6 months after conversion. Patients who did not undergo a conversion attempt (n = 53) had follow-up at 6 months after implant.Results
All implants were successful. One 7-day migration to the right atrium required surgical removal. Technical success rate for filter conversion was 92.7% (89/96). Mean time from placement to conversion was 130.7 days (range, 15–391 d). No major conversion-related events were reported. The mean conversion procedure time was 30.7 minutes (range, 7–135 min). There were 89 converted and 32 unconverted patients who completed 6-month follow-up with no delayed complications.Conclusions
The VenaTech Convertible filter has a high conversion rate and low 6-month device-related adverse event rate. Further studies are necessary to determine long-term safety and efficacy in both converted and unconverted patients. 相似文献4.
Joseph L. McDevitt Ali Alian Baljendra Kapoor Stacy Bennett Amanjit Gill Abraham Levitin Mark Sands K.V. Narayanan Menon Federico N. Aucejo Bassam Estfan Anil K. Pillai Sanjeeva P. Kalva Gordon McLennan 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1371-1377
Purpose
To compare overall survival and toxicities after yttrium-90 (90Y) radioembolization and chemoembolization with drug-eluting embolics (DEE) in patients with infiltrative hepatocellular carcinoma (HCC).Materials and Methods
Retrospective review of 50 patients with infiltrative HCC without main portal vein invasion who were treated with 90Y radioembolization (n = 26) or DEE chemoembolization (n = 24) between March 2007 and August 2012 was completed. Infiltrative tumors were defined by cross-sectional imaging as masses that lacked well-demarcated boundaries, and treatment allocations were made by a multidisciplinary tumor board. Median age was 63 years; median tumor diameter was 9.0 cm; and there were no significant differences between groups in performance status, severity of liver disease, or HCC stage. Toxicities were graded by Common Terminology Criteria for Adverse Events v4.03. Overall survival from treatment was assessed by Kaplan-Meier analysis, with analysis of potential predictors of survival with log-rank test.Results
There was no difference in the average number of procedures performed in each treatment group (DEE, 1.5 ± 1.1; 90Y, 1.6 ± 0.5; P = .97), and technical success was achieved in all cases. Abdominal pain (73% vs 33%; P = .004) and fever (38% vs 8%; P = .01) were more frequent after DEE chemoembolization. There was no significant difference in median overall survival between treatment groups after treatment (DEE, 9.9 months; 90Y, 8.1 months; P = .11).Conclusions
90Y radioembolization and DEE chemoembolization provided similar overall survival in the treatment of infiltrative HCC without main portal vein invasion. Abdominal pain and fever were more frequent after DEE chemoembolization. 相似文献5.
Hyukjoon Lee Chang Jin Yoon Nak Jong Seong Chang Ho Jeon Ho Il Yoon Joongseok Go 《Journal of vascular and interventional radiology : JVIR》2017,28(8):1161-1166
Purpose
To describe angiographic findings and assess safety and effectiveness of bronchial artery embolization (BAE) with N-butyl cyanoacrylate (NBCA) in patients with cryptogenic hemoptysis (CH).Materials and Methods
Between May 2003 and March 2014, 26 patients who underwent BAE for CH were enrolled. A retrospective review was conducted for angiographic findings and clinical outcomes of BAE, including technical and clinical success, complications, and recurrent hemoptysis.Results
Selective arteriograms were abnormal in 22 patients (85%), showing hypertrophied bronchial arteries (n = 19), parenchymal hypervascularity (n = 18), and bronchial-to-pulmonary shunting (n = 8). All abnormal bronchial and nonbronchial collateral arteries (n = 36) were successfully embolized with NBCA. Hemoptysis ceased within 24 hours in all patients. There were no procedure-related complications. During 11–117 months of follow-up (median, 60.2 mo), 1 patient (4%) experienced recurrent hemoptysis at 5 months after initial BAE, which was treated with repeat BAE. The 5-year hemoptysis-free survival rate was 96%.Conclusions
Bronchial arteries were angiographically abnormal in most patients with CH (85%). BAE is a safe and effective treatment with excellent short- and long-term results in patients with CH. NBCA appears to be a useful embolic material for this application. 相似文献6.
Amar Karalli Ramin Ghaffarpour Rimma Axelsson Lars Lundell Bela Bozoki Torkel Brismar Ove Gustafsson 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1664-1672
Purpose
To prospectively assess feasibility, safety, and cytoreductive effect of transarterial chemoembolization on renal cell carcinoma (RCC) using drug-eluting embolic agent (DEE) saturated with doxorubicin compared with transarterial embolization (TAE).Materials and Methods
Between 2012 and 2015, 12 patients (male/female = 5/7, age 66 y ± 9.8) with biopsy-verified RCC eligible for nephron-sparing surgery or radical nephrectomy were recruited. Mean tumor size was 3.2 cm ± 0.62. Patients were randomized at 1:1 ratio to receive either DEE transarterial chemoembolization or TAE before planned surgery. A microcatheter was used to inject particles selectively into arteries feeding the tumors. Response was evaluated by CT according to modified Response Evaluation Criteria In Solid Tumors and by microscopy of excised tumors. Complications were scored according to the Society of Interventional Radiology classification.Results
DEE transarterial chemoembolization (n = 6) resulted in a significantly (P = .018) higher degree of necrosis with an average of 88.3% (range, 70%–100%) compared with TAE (n = 5), which resulted in an average of 29.4% (range, 0–77%), as evaluated by CT. Histopathologic evaluation showed similar results (P = .016) with an average necrosis of 87.5% (range, 80%–95%) for DEE transarterial chemoembolization (n = 4) versus 26% (range, 0–70%) for TAE (n = 5). Percentage of necrosis seen on microscopy correlated significantly (P = .0005) with radiologic findings, as 4 tumors in each arm were evaluated by both CT and microscopy. No major complications were observed in either group.Conclusions
DEE transarterial chemoembolization is safe for treating localized RCC and has a significantly superior cytoreductive effect compared with TAE. 相似文献7.
Felix G. Meinel Julian L. Wichmann U. Joseph Schoepf Francesca Pugliese Ullrich Ebersberger Gladys G. Lo Yeon Hyeon Choe Yining Wang Christian Tesche Sabrina Segreto Wolfgang G. Kunz Kolja M. Thierfelder Fabian Bamberg Carlo N. De Cecco 《Journal of Cardiovascular Computed Tomography》2017,11(1):16-24
Background
There is no published data on the prognostic value of global myocardial perfusion values at stress dynamic CT myocardial perfusion imaging (CTMPI).Methods
Data of 144 patients from 6 centers who had undergone coronary CT angiography (coronary CTA) and CTMPI were assessed. Coronary CTA studies were acquired at rest; CTMPI was performed under vasodilator stress. Coronary CTA data were evaluated for coronary artery stenosis (≥50% luminal narrowing) on a per-vessel basis. Volumes-of-interest were placed over the entire left ventricular myocardium to obtain global myocardial blood flow (MBF), myocardial blood volume (MBV), and volume transfer constant (Ktrans). Follow-up was obtained at 6/12/18 months. Major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction, unstable angina requiring hospitalization, and revascularization) served as the endpoint.Results
MACE occurred in 40 patients (nonfatal myocardial infarction, n = 1, unstable angina, n = 13, PCI, n = 23, and CABG, n = 3). Patients with global MBF of <121 mL/100 mL/min were at increased risk for MACE (HR 2.07, 95% confidence interval [CI]: 1.12–3.84, p = 0.02). This association remained significant after adjusting for age, gender, and clinical risk factors (HR 2.17, 95%CI: 1.16–4.06, p = 0.02), after further adjusting for presence of ≥50% stenosis at coronary CTA (HR 2.18, 95%CI: 1.16–4.10, p = 0.02) and when excluding early (<6 months) revascularizations (HR 2.34, 95%CI: 1.01–5.43, p = 0.0486). Global MBV and Ktrans were not independent predictors of MACE.Conclusion
Global quantification of left ventricular MBF at stress dynamic CTMPI may have incremental predictive value for future MACE over clinical risk factors and assessment of stenosis at coronary CTA. 相似文献8.
Tricia M. Kleidon Amanda J. Ullman Victoria Gibson Brett Chaseling Jason Schoutrop Gabor Mihala Claire M. Rickard 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1548-1556.e1
Purpose
To evaluate feasibility of an efficacy trial comparing peripherally inserted central catheter (PICC) dressing and securement techniques to prevent complications and failure.Materials and Methods
This pilot, 3-armed, randomized controlled trial was undertaken at Royal Children’s Hospital and Lady Cilento Children’s Hospital, Brisbane, Australia, between April 2014 and September 2015. Pediatric participants (N = 101; age range, 0–18 y) were assigned to standard care (bordered polyurethane [BPU] dressing, sutureless securement device), tissue adhesive (TA) (plus BPU dressing), or integrated securement dressings (ISDs). Average PICC dwell time was 8.1 days (range, 0.2–27.7 d). Primary outcome was trial feasibility including PICC failure. Secondary outcomes were PICC complications, dressing performance, and parent and staff satisfaction.Results
Protocol feasibility was established. PICC failure was 6% (2/32) with standard care, 6% (2/31) with ISD, and 3% (1/32) with TA. PICC complications were 16% across all groups. TA provided immediate postoperative hemostasis, prolonging the first dressing change until 5.5 days compared with 3.5 days and 2.5 days with standard care and ISD respectively. Bleeding was the most common reason for first dressing change: standard care (n = 18; 75%), ISD (n = 11; 69%), TA (n = 4; 27%). Parental satisfaction (median 9.7/10; P = .006) and staff feedback (9.2/10; P = .002) were most positive for ISD.Conclusions
This research suggests safety and acceptability of different securement dressings compared with standard care; securement dressings may also reduce dressing changes after insertion. Further research is required to confirm clinically cost-effective methods to prevent PICC failure. 相似文献9.
Andrew J. Miller Edwin A. Takahashi William S. Harmsen Kristin C. Mara Sanjay Misra 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1681-1686
Purpose
To determine the predictors of restenosis, major adverse limb events (MALEs), postoperative death (POD), and all-cause mortality after repeat endovascular treatment of superficial femoral artery (SFA) restenosis.Materials and Methods
This was a retrospective review of 440 patients with 518 SFA lesions who were treated between January 2002 and October 2011. Ninety-six limbs were treated for restenosis with bare metal stents (BMSs) or percutaneous transluminal angioplasty (PTA), of which 28 limbs developed another restenosis requiring a third procedure. The interaction measured in this study was between the second and third intervention. Predictors of SFA patency, MALEs, POD, and all-cause mortality after SFA restenosis treatment were identified.Results
Patients who were treated with BMSs (n = 51) had similar rates of restenosis compared with patients who were treated with PTA (n = 45) (hazard ratio [HR] 1.40; 95% confidence interval [CI] 0.68–2.90; P = .37). Patients in the BMS group who took statins had a significantly lower risk of restenosis than patients who did not take statins (HR 0.13; 95% CI 0.04–0.41; P < .001). Stage 4–5 chronic kidney disease (CKD) (n = 12) was associated with a significantly higher risk of MALE + POD (HR 6.17; 95% CI 1.45–26.18; P = .014) and all-cause mortality (HR 2.83; 95% CI 1.27–6.33; P = .01). Clopidogrel was protective against all-cause mortality (HR 0.41; 95% CI 0.20–0.80; P = .01).Conclusions
Patients in the BMS group who took statins at the time of intervention had a significantly lower risk of developing restenosis. Stage 4–5 CKD was a risk factor for MALE + POD and all-cause mortality, while clopidogrel decreased all-cause mortality risk. 相似文献10.
Jeffrey Forris Beecham Chick Alexandria Jo J. Matthew Meadows Steven D. Abramowitz Minhaj S. Khaja Kyle J. Cooper David M. Williams 《Journal of vascular and interventional radiology : JVIR》2017,28(7):933-939
Purpose
To report technical success, outcomes, and patency of iliocaval stent reconstruction for inferior vena cava (IVC) filter–bearing iliocaval thrombosis.Materials and Methods
A total of 120 patients with 123 IVC filters and symptomatic iliocaval thrombosis underwent stent reconstruction. Mean patient age was 55 years (range, 19-88 y). Filters included 70 (57%) retrievable and 53 (43%) permanent filters. Symptoms included lower extremity swelling or pain (n = 93), ulcers (n = 8), phlegmasia (n = 7), back pain (n = 5), shortness of breath (n = 4), worsening renal function (n = 2), and stenosis identified during translumbar catheter placement (n = 1). Clinical success was defined as decrease in clinical, etiology, anatomy, and pathophysiology (CEAP) score of at least 1; resolution of presenting symptoms; or normalization of renal function in patients with juxtarenal or suprarenal thrombosis on presentation. Technical aspects of reconstruction, technical success, complications, 6-month clinical response, and 6-, 12-, and 24-month primary, primary-assisted, and secondary stent patency rates were recorded.Results
Stent reconstruction was technically successful in all 120 patients, 63 of whom (53%) underwent thrombolysis. Thirty filters (24%) were retrieved, and 93 (76%) were excluded with stent placement across the indwelling filter. Six minor and 2 major complications occurred. Clinical success was achieved in 115 patients (96%) at 6 months. Six-, 12-, and 24-month primary iliocaval stent patency rates were 96.4%, 94.8%, and 87.2%, respectively. Twenty-four month primary-assisted and secondary patency rates were 90.3% and 94.2%, respectively.Conclusions
Iliocaval stent reconstruction is an effective treatment for filter-associated thrombosis with 100% technical success and 96% clinical success at 6 months. Technical and clinical outcomes in patients who underwent filter retrieval versus filter exclusion were similar. 相似文献11.
Camillo Aliberti Riccardo Carandina Sara Lonardi Vincenzo Dadduzio Alessandro Vitale Enrico Gringeri Giacomo Zanus Umberto Cillo 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1495-1502
Purpose
To assess the safety, tolerability, and efficacy of small drug-eluting embolic (DEE) agents (70–150 μm) for chemoembolization of hepatocellular carcinoma (HCC).Materials and Methods
This single-center, single-arm, retrospective study involved 421 patients (mean age, 66.1 y ± 9.8 [standard deviation]) with Barcelona Clinic Liver Cancer (BCLC) stage A (n = 88), B (n = 140), or C (n = 193) HCC and Child–Pugh class A (n = 233) or B (n = 188) cirrhosis. Patients had a mean of 7.2 lesions ± 4.8 (range, 1–21; mean diameter of target lesion, 21.4 cm ± 8.1; unilobar, n = 132; bilobar, n = 289; portal vein involvement, n = 193). One (n = 320) or 2 (n = 101) vials of small DEEs loaded with doxorubicin 50 mg per vial were delivered selectively (ie, segmentally) or superselectively (ie, directly into the tumor-feeding vessel) until complete delivery or stasis/near-stasis. Treatment was repeated in patients with partial response or stable disease at 1- or 3-month follow-up (mean, 2.0 cycles ± 0.9). Adverse events within 30 days of chemoembolization, response per modified Response Evaluation Criteria In Solid Tumors (mRECIST), and survival were assessed.Results
Within 30 days after treatment, no deaths or bleeding events occurred, but all patients had at least 1 episode of postembolization syndrome (pain, fever, and/or nausea/vomiting; 27.1% grade 3/4 per National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0) and increased bilirubin and liver aminotransferase levels (0.2% and 5.9% grade 3/4, respectively). Overall response rates were 94.5% at 3 months and 99.5% at 6 months. Median overall survival was 42.0 months (95% confidence interval, 38.0–43.0 mo).Conclusions
Chemoembolization with small DEE agents is well tolerated and an effective treatment for a broad range of patients with liver-confined HCC. 相似文献12.
Saebeom Hur Hwan Jun Jae Hyukjoon Lee Myungsu Lee Hyo-Cheol Kim Jin Wook Chung 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1673-1680
Purpose
To evaluate 30-day safety and efficacy of superselective embolization for arterial upper gastrointestinal bleeding (UGIB) using N-butyl cyanoacrylate (NBCA).Materials and Methods
This single-center retrospective 10-year study included 152 consecutive patients with UGIB (gastric, n = 74; duodenal, n = 78) who underwent embolization with NBCA for angiographically positive arterial bleeding. The primary endpoint was clinical success rate defined as achievement of hemostasis without rebleeding or UGIB-related mortality within 30 days after embolization. Mean systolic blood pressure and heart rate were 121.2 mm Hg ± 27.4 and 97.9 beats/minute ± 22.5; 31.1% of patients needed intravenous inotropes, and 36.6% had coagulopathy. The etiology of bleeding was ulcer (80.3%) or iatrogenic injury (19.7%). Statistical analysis was performed to identify predictive factors for outcomes.Results
Technical success rate was 100%. Clinical success, 1-month mortality, and major complication rates were 70.4%, 22.4%, and 0.7%. There were significant differences in the clinical success rates between gastric and duodenal bleeding (79.4% vs 62.2%; P = .025). The need for intravenous inotropes at the time of embolization was a significant negative predictive factor in both gastric (odds ratio [OR] = 0.091, P = .004) and duodenal (OR = 0.156, P = .002) bleeding. The use of a microcatheter with a smaller tip (2 F) was associated with better outcomes in duodenal bleeding (OR = 7.389, P = .005).Conclusions
Superselective embolization using NBCA is safe and effective for angiographically positive arterial UGIB. 相似文献13.
Yu-Kai Su Rosewell V. Mackey Ahsun Riaz Vanessa L. Gates Al B. Benson Frank H. Miller Vahid Yaghmai Ahmed Gabr Riad Salem Robert J. Lewandowski 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1520-1526
Purpose
To determine long-term hepatotoxicity of yttrium-90 (90Y) radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms.Materials and Methods
Retrospective review from 2003 to 2016 was performed for patients with mNET treated with 90Y glass microspheres. Fifty-four patients with > 2 year follow-up were stratified into unilobar (n = 15) vs whole-liver (n = 39) treatment. The most common primary mNET sites were small bowel (19 of 54), pancreas (19 of 54), and unknown (8 of 54). Preradioembolization imaging and laboratory findings were compared with most recent follow-up for indications of worsening portal hypertension and decline in hepatic function.Results
Among patients who underwent unilobar radioembolization, imaging follow-up at a mean of 4.1 years (range, 2.0–15.2 y) revealed cirrhosis-like morphology in 26.7% (4 of 15), ascites in 13.3% (2 of 15), varices in 6.7% (1 of 15), and a 21.9% increase in splenic volume. The respective incidences in patients treated with whole-liver 90Y radioembolization were 56.4% (22 of 39), 41.0% (16 of 39), and 15.4% (6 of 39), with a 64.7% increase in splenic volume. Patients treated with whole-liver radioembolization exhibited significantly decreased platelet counts (P = .023) and lower albumin levels (P = .0002). Eight patients (20.5%) treated with whole-liver radioembolization who exhibited cirrhosis-like morphology showed clinical signs of hepatic decompensation; only 2 of 39 patients (5.1%) had no other causes of hepatotoxicity.Conclusions
Whole-liver 90Y radioembolization for patients with mNET results in long-term imaging findings of cirrhosis-like morphology and portal hypertension in > 50% of treated patients, but the majority remain clinically asymptomatic. Long-term hepatotoxicity solely attributable to 90Y develops in a small percentage of patients. 相似文献14.
15.
Ron C. Gaba James T. Bui Rajyasree Emmadi Janesh Lakhoo 《Journal of vascular and interventional radiology : JVIR》2017,28(6):906-912.e1
Purpose
To test the hypothesis that a modified approach to portal vein embolization (PVE)—termed ablative liver partition (ALP) and PVE (ALP-PVE)—is feasible and results in greater future liver remnant (FLR) growth compared with PVE alone in a rabbit model.Materials and Methods
Eighteen rabbits (median weight, 2.7 kg) underwent PVE (n = 9) or ALP-PVE (n = 9). PVE to cranial liver lobes was performed with 100–300-μm microspheres and metallic coils; the caudal lobe was spared as the FLR. In the ALP-PVE cohort, a liver partition between cranial and caudal lobes was created by using microwave ablation (40 W, 1 min). Animals were euthanized and livers were harvested on postprocedure day 7. Caudal and cranial liver lobes were weighed after 4 weeks of oven drying. Ki-67 immunohistochemistry was used to quantify liver mitotic index. ALP-PVE feasibility was determined based on procedure technical success. Standardized FLR (sFLR; ie, FLR divided by whole liver weight) and mitotic index were compared between PVE and ALP-PVE groups by two-tailed independent-samples Mann–Whitney U test.Results
One PVE-group rabbit died during anesthesia induction and was excluded from technical success calculation. Eight of 8 (100%) and 8 of 9 rabbits (89%) underwent technically successful PVE and ALP-PVE, respectively. There was no difference in sex or weight distribution between groups. sFLR (0.32 vs 0.29; P = .022) and mitotic index (17.5% vs 6.2%; P = .051) were higher in ALP-PVE vs PVE caudal lobes when the first “learning-curve” case from each group was excluded.Conclusions
ALP-PVE is feasible and may stimulate greater FLR growth compared with PVE in a rabbit model. 相似文献16.
Jung-Hoon Park Guk Bae Kim Ho-Young Song Min Tae Kim Pyeong Hwa Kim Kun Yung Kim Jiaywei Tsauo Do Hoon Kim 《Journal of vascular and interventional radiology : JVIR》2017,28(8):1147-1153
Purpose
To evaluate the frequency, severity, and clinical significance of stent abutment (SA) after gastroduodenal stent placement in patients with gastric outlet obstruction caused by unresectable gastric cancer.Materials and Methods
A retrospective study was conducted in a single tertiary referral university hospital to identify the incidence and clinical significance of SA in 318 patients who underwent self-expandable metallic stent placement. SA was defined as abutment of the distal end of the stent to the duodenal wall and/or superior duodenal flexure. The outcomes included technical and clinical success, complications, repeat intervention, stent patency, and survival.Results
A total of 318 patients, 107 with SA (33.6%) and 211 without, were included. SA occurred partially (n = 64; 59.8%) and completely (n = 43; 40.2%). The technical and clinical outcomes and survival were similar in the groups with and without SA. Food impaction and resultant repeat intervention rates were higher in the SA group than in the non-SA group (P < .001 and P < .001, respectively), and were associated with complete SA (P = .007). Stent patency rate was lower in the SA group than in the non-SA group (P = .003).Conclusions
SA was associated with increased food impaction, resulting in a greater incidence of stent malfunction and shorter stent patency compared with a lack of SA. The concept of SA may be useful for the improvement of stent patency and avoidance of food impaction. 相似文献17.
Harshna V. Vadvala Vanessa Fiorini Furtado Avinash Kambadakone Nathan E. Frenk Peter R. Mueller Ronald S. Arellano 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1569-1576
Purpose
To assess biopsy technique, technical success rate, and diagnostic yield of image-guided percutaneous biopsy of omental and mesenteric lesions.Materials and Methods
This retrospective study included 186 patients (89 men, 97 women; mean [SD] age, 63 [13.8] y) who underwent percutaneous image-guided biopsy of omentum and mesentery between March 2007 and August 2015. Biopsies were performed with computed tomography (CT) (n = 172) or ultrasound (US) (n = 14) guidance using coaxial technique yielding core and fine-needle aspiration (FNA) specimens. Biopsy results were classified as diagnostic (neoplastic or nonneoplastic) or nondiagnostic based on histopathology and cytology. Technical success rate and diagnostic yield of omental and mesenteric lesions were calculated.Results
There were 186 image-guided percutaneous biopsies of omental (n = 95) and mesenteric (n = 91) lesions performed. Technical success rate was 99.5% for all biopsies, 100% for omental biopsies, and 98.9% for mesenteric biopsies. Overall sensitivity was 95.5%, specificity was 100%, negative predictive value was 78.3%, and positive predictive value was 100%, which was comparable for omental and mesenteric biopsies. Core biopsies had higher diagnostic yields compared with FNA: 98.4% versus 84% overall, 99% versus 88% for omental biopsies, and 97.7% versus 80% for mesenteric biopsies. Spearman rank correlation showed no correlation between lesion size and diagnostic yield (P = .14) and lesion depth and diagnostic yield (P = .29) for both groups. There were 5 complications.Conclusions
Image-guided percutaneous omental and mesenteric biopsies have high technical success rates and diagnostic yield regardless of lesion size or depth from the skin for both omental and mesenteric specimens. 相似文献18.
Jason Chiang Kwang Nickel Randall J. Kimple Christopher L. Brace 《Journal of vascular and interventional radiology : JVIR》2017,28(7):1053-1058
Purpose
To evaluate potential biologic and thermal mechanisms of the observed differences in thrombosis rates between hepatic vessels during microwave (MW) ablation procedures.Materials and Methods
MW ablation antennae were placed in single liver lobes of 2 in vivo porcine liver models (n = 3 in each animal; N = 6 total) in the proximity of a large (> 5 mm) portal vein (PV) and hepatic veins (HVs). Each ablation was performed with 100 W for 5 minutes. Conventional ultrasound imaging and intravascular temperature probes were used to evaluate vessel patency and temperature changes during the ablation procedure. Vascular endothelium was harvested 1 hour after ablation and used to characterize genes and proteins associated with thrombosis in PVs and HVs.Results
Targeted PVs within the MW ablation zone exhibited thrombosis at a significantly higher rate than HVs (54.5% vs 0.0%; P = .0046). There was a negligible change in intravascular temperature in PVs and HVs during the ablation procedure (0.2°C ± 0.4 vs 0.6°C ± 0.9; P = .46). PVs exhibited significantly higher gene expression than HVs in terms of fold differences in thrombomodulin (2.9 ± 2.0; P = .0001), von Willebrand factor (vWF; 7.6 ± 1.5; P = .0001), endothelial protein C receptor (3.50 ± 0.49; P = .0011), and plasminogen activator inhibitor (1.46 ± 0.05; P = .0014). Western blot analysis showed significantly higher expression of vWF (2.32 ± 0.92; P = .031) in PVs compared with HVs.Conclusions
Large PVs exhibit thrombosis more frequently than HVs during MW ablation procedures. Biologic differences in thrombogenicity, rather than heat transfer, between PVs and HVs may contribute to their different rates of thrombosis. 相似文献19.
Marta Burrel Marta Barrufet Maria Carme Sebastia Jonathan Joudanin Laura Buñesch Patricia Bermudez Jordi Blasco Rosa Gilabert 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1557-1562.e1
Purpose
To describe radiologic findings, embolization technique, and clinical outcomes in patients with renal subcapsular hematoma and diffuse cortical hemorrhage.Materials and Methods
Ten patients with renal subcapsular hematoma and diffuse cortical hemorrhage were reviewed. Nine of the 10 had undergone procedures (nephrostomy, n = 4; biopsy, n = 4; embolization of a cerebral aneurysm, n = 1) and 1 patient was receiving oral anticoagulation. Computed tomography (CT), angiography, and embolization of bleeding sites were performed in all patients.Results
CT and angiography revealed subcapsular hematoma with diffuse cortical hemorrhage at the level of the interlobar and/or arcuate branches. Total embolization of intrarenal arterial branches was required in 3 patients. Partial embolization, which also resulted in permanent functional loss, was required in 4. The functional loss was likely caused by the embolization procedure and the underlying renal disease. In these 4 patients, renal failure was demonstrated by scintigraphy in 3 cases and based on the need to start chronic hemodialysis in 1 case. In the remaining three patients, embolization did not compromise renal function.Conclusions
Diffuse cortical hemorrhage unrelated to the site of puncture may be seen in some cases of subcapsular hematoma. The cause is likely the laceration of transcortical capsular arteries secondary to enlargement of the subcapsular hematoma. In the present case series, embolization achieved hemorrhage control, but loss of renal function was observed in patients with underlying renal disease. 相似文献20.
Sangik Park Ji Hoon Shin Dong-Il Gwon Hyoung Jung Kim Kyu-Bo Sung Hyun-Ki Yoon Gi-Young Ko Heung Kyu Ko 《Journal of vascular and interventional radiology : JVIR》2017,28(7):1012-1021