Conventional endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm (AAA) requires adequate graft seal proximally in the infrarenal aorta and distally in the common or external iliac arteries. When possible, sealing in the common iliac artery is performed to maintain perfusion to the internal iliac artery. Approximately 40% of AAAs have associated common iliac artery aneurysms that would require an external iliac seal zone and ipsilateral internal iliac artery embolization to prevent a type II endoleak. Concurrent or staged internal iliac artery occlusion may result in pelvic ischemia, which commonly manifests as buttock claudication or, in men, impotence. Uncommon but more serious consequences include colonic and spinal artery ischemia. Coverage or embolization of a single internal iliac artery is generally well tolerated. There is a varied incidence (20 to 50%) of clinically significant buttock claudication that tends to improve over time resulting in ∼10% incidence of buttock claudication at 1 year with single hypogastric artery embolization.
Systemic hypertension is a major burden to the individual and society. Its association with major adverse cardiac and cerebral events and favorable effects of antihypertensive therapy are undisputed. However, despite multidrug therapy, blood pressures are frequently suboptimally controlled. Moreover, adverse drug effects often interfere with patients lifestyles and affect compliance. Therefore, alternative treatment strategies have been explored. Most recently, attention has been redirected to the sympathetic nervous system (SNS) in the pathogenesis of hypertension. In addition, interruption of the renal SNS in humans with resistant hypertension has been studied with promising results. The following review provides an overview of the anatomy and physiology of the renal SNS, the rational for manipulating the SNS, and the results of therapeutic renal sympathetic denervation.
Purpose: To evaluate long-term results of endovascular procedures in treatment of venous juxta-anastomotic stenoses (JASs) of native forearm radiocephalic arteriovenous fistulas (AVFs) and to identify prognostic factors influencing these results.
Purpose: To evaluate dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging for monitoring and assessing treatment response in patients with neuroendocrine liver metastases treated using yttrium 90 (90Y)-labeled octreotide (90Y-DOTATOC).
OBJECTIVE. The purpose of this article is to document our experiences with ultraselective arterial embolization to manage acute colonic hemorrhage using a 1.7-French microcatheter with small-sized detachable coils and to discuss the feasibility and clinical efficacy of this new technique.
AIM: To determine whether fluid injection during radiofrequency ablation (RFA) can increase the coagulation area.
Purpose: To retrospectively evaluate cost and mortality in 84 patients older than 65 years of age with stage IA or IB non–small-cell lung cancer treated with radiofrequency (RF) ablation or limited surgical resection (ie, wedge resection or segmentectomy) from the perspective of the payer, Medicare.
OBJECTIVE. The objective of this study was to compare the performance and radiation doses of a flat-panel detector (FPD) angiography machine with an image intensifier (II) angiography machine.
AIM: To evaluate the complications and clinical outcomes of transcatheter arterial embolization (TAE) for symptoms related to severe arterioportal fistulas (APFs).
Background : In the United States, it is estimated that 5–12 million people have peripheral arterial disease (PAD) (1). The prevalence of PAD increases with age and is estimated to afflict 4.3% of the population>40 years of age and 14.5% of those>70 (2). Depending on the severity and extent of the disease, patients may be asymptomatic or present with clinical symptoms including atypical leg pain, classic intermittent claudication, acute limb ischemia, or chronic critical limb ischemia (CLI). The incidence of CLI is 500–1,000 patients per 1 million in the Western world (2). The natural history of patients with CLI is poor (25% mortality and 30% amputation rate at 1 year) 3, 4, 5. Patients with CLI have advanced atherosclerosis involving all cardiovascular beds and thus have greater 5-year mortality than patients with symptomatic coronary artery disease. Although the precise mechanisms associated with these high mortality and amputation rates is not known, individuals with CLI are known to suffer from increased rates of comorbidities, including poorly controlled atherosclerosis risk factors (eg, smoking, diabetes, hypertension, and hypercholesterolemia), advanced chronic kidney disease, and coronary artery disease (6).
Purpose: To compare retrospectively the effects of percutaneous radiofrequency (RF) ablation with those of hepatic resection in the treatment of hepatocellular carcinoma (HCC) measuring 2 cm or smaller.
OBJECTIVE. The purpose of this study was to assess the safety of hepatic arterial infusion (HAI) chemotherapy after pancreatectomy for pancreatobiliary cancer.
Hemothorax due to rupture of metastatic hepatocellular carcinoma (HCC) is a very rare complication with high mortality because of uncontrollable hemorrhage. A 71-year-old man treated by transcatheter arterial embolization for HCC with massive bleeding from chest wall metastasis is reported. Enhanced computed tomography and selective intercostal angiogram showed a hypervascular mass in the right chest wall and extravasation of contrast agent. After successful transcatheter arterial embolization with gelatin sponge particles and metallic coils, the patient recovered from shock without major complication. To our knowledge, a successfully treated case of hemothorax due to rupture of metastatic HCC has not previously been described.
OBJECTIVE. The purpose of this article is to evaluate the feasibility and efficacy of preoperative percutaneous transhepatic portal vein embolization with ethanol injection.
Nowadays, hepatocellular carcinoma (HCC) is frequently diagnosed at an early stage, opening good perspectives to radical treatment by means of liver transplantation, surgical resection, or percutaneous ablation. Liver transplantation is considered the best option, but the lack of liver donors represents a major limitation. Therefore, surgical resection, offering a 5-year-survival rate of over 50%, is considered the first-choice treatment for patients with early stage HCC, whereas percutaneous ablation is usually reserved to patients who are not candidate to surgery. However, in the recent years some trials showed that percutaneous radiofrequency ablation (RFA) can be as effective as surgical resection in terms of overall survival and recurrence-free survival rates in patients with small HCC, and a retrospective comparative study reported 1-, 3-, and 5-year overall survival rates and recurrence-free survival rates significantly better in patients with central HCC measuring 2 cm or smaller treated with RFA than in those treated with surgical resection. RFA is less expensive, less invasive, with lower complication rate and shorter hospital stay than surgical resection, and on the basis of the results of these studies it should be considered the first option in the treatment of very early HCC. However, RFA is size-dependent, so at present the need to achieve an adequate safety margin around the tumor limits to about 2 cm the diameter of the nodules that can be ablated with long-term outcomes comparable to or better than surgical resection. The main goal of the next technical developments of the thermal ablation systems should be the achievement of larger ablation areas with a single needle insertion. In this regard, the recent improvements in microwave energy delivery systems seem to open interesting perspectives to percutaneous microwave ablation, which could become the ablation technique of choice in the next future.
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