Tranarterial chemoembolization (TACE) has been established by a meta-analysis of randomized controlled trials as the standard of care for nonsurgical patients with large or multinodular noninvasive hepatocellular carcinoma (HCC) isolated to the liver and with preserved liver function. Although conventional TACE with administration of an anticancer-in-oil emulsion followed by embolic agents has been the most popular technique, the introduction of embolic drug-eluting beads has provided an alternative to lipiodol-based regimens. Experimental studies have shown that TACE with drug-eluting beads has a safe pharmacokinetic profile and results in effective tumor killing in animal models. Early clinical experiences have R. Lencioni (&) Division of Diagnostic Imaging and Intervention, Pisa University Hospital, University of Pisa, Building No. 29, 2nd floor, Via Paradisa 2, 56124 Pisa, IT, Italy e-mail: riccardo.lencioni@med.unipi.it T. de Baere Department of Interventional Radiology, Institut Gustav-Roussy, 114 rue E ´ douard-Vaillant, 94805 Villejuif Cedex, France M. Burrel M. I. Real Department of Radiology, Barcelona Clinic for Liver Cancer, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain J. G. Caridi Division of Interventional Radiology, University of Florida, P.O. Box 100374, Gainesville, FL 32610-0374, USA J. Lammer Department of Interventional Radiology, Medical University of Vienna, Guertel 18-20, 1090 Vienna, Austria K. Malagari Department of Radiology, University of Athens, Papadiamandopoulou Street, Ilisia, 11528 Athens, Greece • • • Elizabeth O’Grady Jean-Francois H. Geschwind • confirmed that drug-eluting beads provide a combined ischemic and cytotoxic effect locally with low systemic toxic exposure. Cardiovasc Intervent Radiol. Copyright © The Author(s) 2011. This article is published with open access at Springerlink.com
Splenic artery embolization (SAE) is a well-established method for treating traumatic splenic hemorrhage as well as splenic neoplasms [1–3]. This procedure may provide an alternative to open surgery. However, there are risks involved with SAE, mainly due to possible complications after the procedure. Most frequent complications are lactate acidosis, sepsis, renal insufficiency, and bowel perforation. We describe a patient with malignant hypersplenism who underwent SAE to treat severe thrombocytopenia. Complications several days after the procedure included bowel necrosis, probably caused by an occult pheochromocytoma and triggered by stress caused by the procedure. Cardiovasc Intervent Radiol. Copyright © The Author(s) 2011. This article is published with open access at Springerlink.com.
Liver cirrhosis is associated with higher morbidity and reduced survival with appearance of portal hypertension and resultant decompensation. Portal decompression plays a key role in improving survival in these patients. Transjugular intrahepatic portosystemic shunts are known to be efficacious in reducing portal venous pressure and control of complications such as variceal bleeding and ascites. However, they have been associated with significant problems such as poor shunt durability, increased encephalopathy, and unchanged survival when compared with conservative treatment options. The last decade has seen a significant improvement in these complications, with introduction of covered stents, better selection of patients, and clearer understanding of procedural end-points. Use of TIPS early in the period of decompensation also appears promising in further improvement of survival of cirrhotic patients. SAGE-Hindawi Access to Research International Journal of Hepatology Volume 2011, Article ID 398291. Copyright © 2011 S. J. Punamiya and D. N. Amarapurkar. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Variceal hemorrhage is a major cause of death in patients with cirrhosis. Over the past two decades new treatment modalities have been introduced in the management of acute variceal bleeding (AVB) and several recent studies have suggested that the outcome of patients with cirrhosis and AVB has improved. Improved supportive measures, combination therapy which include early use of portal pressure reducing drugs with low rates of adverse effects (somatostatin, octerotide or terlipressin) and endoscopic variceal ligation has become the first line treatment in the management of AVB. Short-term antibiotic prophylaxis, early use of lactulose for prevention of hepatic encephalopathy, application of early transjugular intrahepatic portasystemic shunts (TIPS), fully covered self-expandable metallic stent in patients for AVB may be useful in those cases where balloon tamponade is considered. Early and wide availability of liver transplantation has changed the armamentarium of the clinician for patients with AVB. High hepatic venous pressure gradient (HVPG) >20 mmHg in AVB has become a useful predictor of outcomes and more aggressive therapies with early TIPS based on HVPG measurement may be the treatment of choice to reduce mortality further. SAGE-Hindawi Access to Research International Journal of Hepatology Volume 2011, Article ID 356919. Copyright © 2011 P. Sharma and S. K. Sarin. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Chylous leaks, such as chylothorax and chylopericardium, are uncommon effusions resulting from the leakage of intestinal lymphatic fluid from the thoracic duct (TD) and its tributaries, or intestinal lymphatic ducts. The cause can be either traumatic (thoracic surgery) or nontraumatic (idiopathic, malignancy). Treatment has traditionally consisted of dietary modification (nonfat diet) and/or surgery (TD ligation, pleurodesis). Thoracic duct embolization (TDE) has become a viable treatment alternative due to it high success rate and minimal complications. In this article, the authors describe the etiologies of chylothorax, patient population, outcomes, and long-term follow-up of TDE patients. Relevant lymphatic anatomy and physiology are reviewed, with special attention paid to the formation of the duct by tributaries at the cisterna chyli (CC). The technique of TDE is outlined, including bilateral pedal lymphangiography, TD cannulation, and embolic agents used for the procedure. SEMINARS IN INTERVENTIONAL RADIOLOGY/VOLUME 28, NUMBER 1 2011. Semin Intervent Radiol 2011;28:63–74. Copyright © 2011 by Thieme Medical Publishers, Inc.
Degenerative aneurysms of the thoracic aorta are increasing in prevalence; open repair of descending thoracic aortic aneurysms is associated with high rates of morbidity and mortality. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair. The cornerstones of successful thoracic endovascular aneurysm repair are appropriate patient selection, thorough preprocedural planning, and cautious procedural execution, the elements of which are discussed here. SEMINARS IN INTERVENTIONAL RADIOLOGY/VOLUME 28, NUMBER 1 2011. Semin Intervent Radiol 2011;28:107–117. Copyright © 2011 by Thieme Medical Publishers, Inc.
Translocation of gut-derived bacterial products such as endotoxin is a major problem in liver cirrhosis. Benten et al. BMC Gastroenterology 2011, 11:107. Copyright © 2011 Benten et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Percutaneous radiofrequency ablation (RFA) has gained wide acceptance as nephron-sparing therapy for small renal masses in select patients. Generally, it is a safe procedure with minor morbidity and acceptable short-term oncologic outcome. However, as a result of the close proximity of vital structures, such as the bowel, ureter, and large vessels, to the ablative field, complications regarding these structures may occur. This is the first article describing appendiceal perforation as a complication of computed tomography-guided RFA despite hydrodissection. When performing this innovative and promising procedure one should be aware of the possibility of particular minor and even major complications. Cardiovasc Intervent Radiol. Copyright © The Author(s) 2011. This article is published with open access at Springerlink.com
Kidney transplantation can be complicated by infection and subsequent development of mycotic aneurysm, endangering the survival of the graft and the patient. Management of this condition in five cases is discussed, accompanied by a review of the relevant literature. Leonardou et al. Journal of Medical Case Reports 2012, 6:59 http://www.jmedicalcasereports.com/content/6/1/59. Copyright © 2012 Leonardou et al; licensee BioMed Central Ltd.
This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA. Cardiovasc Intervent Radiol (2011) 34:S57–S59. Copyright The Author(s) 2010. This article is published with open access at Springerlink.com
To assess current uterine fibroid embolisation (UFE) practice in European countries and determine the clinical environment for UFE in different hospitals. Material and Methods In May 2009, an invitation for an online survey was sent by e-mail to all members of the Cardiovascular and Interventional Radiologic Society of Europe, representing a total number of 1,250 different candidate European treatment centres. The survey covered 21 questions concerning local UFE practice. Cardiovasc Intervent Radiol (2011) 34:765–773. Copyright The Author(s) 2010. This article is published with open access at Springerlink.com
Venous stenting has been shown to effectively treat iliofemoral venous obstruction with good short- and mid-term results. The aim of this study was to investigate long-term clinical outcome and stent patency. Twenty patients were treated with venous stenting for benign disease at our institution between 1987 and 2005. Fifteen of 20 patients (15 female, mean age at time of stent implantation 38 years [range 18–66]) returned for a clinical visit, a plain X-ray of the stent, and a Duplex ultrasound. Four patients were lost to follow-up, and one patient died 277 months after stent placement although a good clinical result was documented 267 months after stent placement. Mean follow-up after stent placement was 167.8 months (13.9 years) (range 71 (6 years) to 267 months [22 years]). No patient needed an additional venous intervention after stent implantation. Cardiovasc Intervent Radiol (2011) 34:542–549. Copyright The Author(s) 2010. This article is published with open access at Springerlink.com
Thrombotic and embolic vascular occlusion represents a leading cause of morbidity and mortality. Currently available thrombectomy devices have limitations, including difficulty removing organized thrombus and clot fragmentation with distal embolization. A novel mechanical thrombectomy device (MTD), designed to remove both hard and soft thrombus without trauma to the blood vessel, was tested in preclinical porcine models evaluating efficacy, safety, and ease of use. Cardiovasc Intervent Radiol (2011) 34:383–390. Copyright The Author(s) 2010. This article is published with open access at Springerlink.com
The primary purpose of this study was to demonstrate intraobserver/interobserver reproducibility for novel semiautomated measurements of hepatic volume used for Yttrium-90 dose calculations as well as whole-liver and necrotic-liver (hypodense/nonenhancing) tumor volume after radioembolization. The secondary aim was to provide initial comparisons of tumor volumetric measurements with linear measurements, as defined by Response Evaluation Criteria in Solid Tumors criteria, and survival outcomes. Methods Between 2006 and 2009, 23 consecutive radioembolization procedures were performed for 14 cases of hepatocellular carcinoma and 9 cases of hepatic metastases. Baseline and follow-up computed tomography obtained 1 month after treatment were retrospectively analyzed. Three observers measured liver, whole-tumor, and tumornecrosis volumes twice using semiautomated software. Cardiovasc Intervent Radiol (2011) 34:306–318. Copyright The Author(s) 2010. This article is published with open access at Springerlink.com
To evaluate the accuracy and technical success of positioning a radiofrequency ablation (RFA) electrode in osteoid osteomas by use of a new real-time needle guidance technology combining cone-beam computed tomography (CT) and fluoroscopy. Cardiovasc Intervent Radiol (2011) 34:180–183. Copyright The Author(s) 2010. This article is published with open access at Springerlink.com
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