01 enero 2014

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Late Emergence of Contrast-enhancing Fat Necrosis Mimicking Tumor Seeding after Renal Cryoablation

Jeremy C. Durack, MD , Bertrand Richioud, MD , James Lyon, MD , Stephen B. Solomon, MD

Abstract: Defining radiographic treatment success after percutaneous renal ablation is challenging due to variable ablation zone imaging findings over time. The present report describes two cases of progressively more evident enhancing soft-tissue nodules in the perinephric fat more than 2 years after cryoablation. Despite features concerning for tumor recurrence on computed tomography and magnetic resonance imaging, biopsies revealed fat necrosis in both cases. Renal ablation zone soft-tissue nodules can appear long after ablation, enhance with contrast medium, mimic applicator tract or ablation zone tumor seeding, and may require biopsy for confirmation of benignity.

01 enero 2014

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Embolization of Bronchial Artery–supplied Ectopic Parathyroid Adenomas Located in the Aortopulmonary Window

Mujtaba Ali, MD , David A. Kumpe, MD

Abstract: Ectopic parathyroid adenomas in the aortopulmonary window (APW) are extremely rare, constituting only 1% of ectopic mediastinal adenomas and 0.24% of all parathyroid adenomas. The authors have encountered three patients with ectopic adenomas in the APW. In each case, the primary arterial supply to the APW adenoma arose from the bronchial artery. In addition, there was a small anastomotic arterial channel connecting the bronchial artery supplying the adenoma to the left inferior thyroid. All three adenomas were treated with transcatheter embolization, with control of hyperparathyroidism in two of three patients. One patient required thoracoscopic removal of the adenoma. It is critical that the interventionalist be aware of this arterial supply pattern to allow successful embolization of an APW ectopic adenoma.

01 enero 2014

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Percutaneous Valvulotomy as an Alternative to Transposition of a Brachiocephalic Fistula

Jeffrey E. Hull, MD , Raymond G. Makhoul, MD , James F. Snyder, MD

Abstract: Transposition of a deep (9–12 mm) autogenous brachiocephalic vein fistula was required for adequate hemodialysis access in a morbidly obese patient. The patient was a poor candidate for surgical transposition of the upper-arm cephalic vein. As an alternative, retrograde fistula flow was established percutaneously through a 6-F sheath in the forearm cephalic vein with the over-the-wire LeMaitre valvulotome. The retrograde flow in the forearm added 7 cm of superficial vein 6.2–9 mm in diameter with a flow rate of 940–2,868 mL/min, eliminating the need for surgical transposition. The percutaneous technique and required anatomy are described.

01 enero 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Factors Affecting Periprocedural Morbidity and Mortality and Long-term Patient Survival after Arterial Embolization of Hepatic Neuroendocrine Metastases

Constantinos T. Sofocleous, MD, PhD , Elena N. Petre, MD , Mithat Gonen, PhD , Diane Reidy-Lagunes, MD , Ivan K. Ip, MD , William Alago, MD , Anne M. Covey, MD , Joseph P. Erinjeri, MD , Lynn A. Brody, MD , Majid Maybody, MD , Raymond H. Thornton, MD , Stephen B. Solomon, MD , George I. Getrajdman, MD , Karen T. Brown, MD

Purpose: To identify factors affecting periprocedural morbidity and mortality and long-term survival following hepatic artery embolization (HAE) of hepatic neuroendocrine tumor (NET) metastases.

01 enero 2014

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Transcatheter Arterial Chemoembolization for Advanced Hepatocellular Carcinoma with Portal Vein Invasion: Safety, Efficacy, and Prognostic Factors

Ming-Chih Chern, MD , Vincent P. Chuang, MD , Chung-Ting Liang, MD , Z.H. Lin, MD , Tse-Ming Kuo, MD

Purpose: To evaluate the safety and efficacy of transarterial chemoembolization and to identify the prognostic factors associated with survival in patients with hepatocellular carcinoma (HCC) and portal vein (PV) invasion.

01 enero 2014

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Early Results from a United States Trial of Prostatic Artery Embolization in the Treatment of Benign Prostatic Hyperplasia

Sandeep Bagla, MD , Cynthia P. Martin, MS , Arletta van Breda, MSN , Michael J. Sheridan, ScD , Keith M. Sterling, MD , Dimitrios Papadouris, MD , Kenneth S. Rholl, MD , John B. Smirniotopoulos, MS , Arina van Breda, MD

Purpose: To report early findings from a prospective United States clinical trial to evaluate the efficacy and safety of prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH).

01 enero 2014

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Risk of Hernia Incarceration following Transjugular Intrahepatic Portosystemic Shunt Placement

Mitchell T. Smith, MD, MS , Benjamin Rase, MD , Alyn Woods, MD , James Trotter, MD , Matt Gipson, MD , Kimi Kondo, DO , Charles Ray, MD, PhD , Janette Durham, MD

Purpose: Hernia complications after creation of a transjugular intrahepatic portosystemic shunt (TIPS) have been reported, although the incidence of this complication is unknown. This study was designed to determine the incidence, morbidity, and outcome of hernia complications in patients with preexisting abdominal or inguinal hernias after TIPS creation.

01 enero 2014

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Percutaneous Endovascular Creation of an Inferior Vena Cava in a Patient with Caval Agenesis, Budd–Chiari Syndrome, and Iliofemorocaval Thrombosis

Ziv J Haskal, MD , Darryn R. Potosky, MD , William S. Twaddell, MD

Abstract: A 29-year-old woman with acute iliofemorocaval thrombosis was discovered to have suprarenal caval agenesis with azygous continuation, hepatic congestion, and fibrosis as a result of chronic Budd–Chiari syndrome. Three staged procedures were performed: pharmacomechanical thrombolysis of acute thromboses, transfemoral liver biopsy and hemodynamic assessment, and percutaneous endovascular creation of a “neocava” lined with endografts. Symptomatic improvement and patency were maintained at 12-week follow-up.

01 enero 2014

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Thermal Ablation Matches Sublobar Resection Outcomes in Older Patients with Early-stage Non–small Cell Lung Cancer

Sharon W. Kwan, MD , Kelly E. Mortell, MD , Adam D. Talenfeld, MD , Michael C. Brunner, MD

Purpose: To compare survival outcomes of sublobar resection and thermal ablation for early-stage non–small cell lung cancer (NSCLC) in older patients.

01 enero 2014

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Safety and Efficacy of Transcatheter Arterial Embolization for Lower Gastrointestinal Bleeding: A Single-center Experience with 112 Patients

Saebeom Hur, MD , Hwan Jun Jae, MD, PhD , Myungsu Lee, MD , Hyo-Cheol Kim, MD, PhD , Jin Wook Chung, MD, PhD

Purpose: To assess the safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding (LGIB) and to determine the prognostic factors that affect clinical outcome.

01 febrero 2013

RADIOLOGY. Neuroendocrine Liver Metastasis Treated by Using Intraarterial Therapy: Volumetric Functional Imaging Biomarkers of Early Tumor Response and Survival

Vivek Gowdra Halappa, MD, , Celia Pamela Corona-Villalobos, MD, , Susanne Bonekamp, DVM, PhD, , Zhen Li, MD, , Diane Reyes, RN, , David Cosgrove, MBBCh, , Timothy M. Pawlik, MD, , Luis Alberto Diaz, MD, , Nikhil Bhagat, MD, , John Eng, MD, , Jean-François Geschwind, MD, and , Ihab R. Kamel, MD, PhD

Introduction: Neuroendocrine tumors are a heterogeneous group of slow-growing hormone-secreting neoplasms that can arise from different organ systems throughout the body, including the gastrointestinal and respiratory systems (1–4). Neuroendocrine tumors are categorized as carcinoid tumors and pancreatic neuroendocrine tumors. Carcinoid tumors arise from the enterochromaffin cells of the gastrointestinal tract and airways, and pancreatic neuroendocrine tumors arise from the islet cells of Langerhans. The overall age-adjusted incidence of carcinoids is about two to three cases per 100 000 per year (3,5) and that of pancreatic neuroendocrine tumors is one per 100 000 per year (6). According to the World Health Organization classification, gastroenteropancreatic neuroendocrine tumors have been classified as neuroendocrine neoplasm grade 1–2 and grade 3 neuroendocrine carcinoma, which includes small cell carcinoma and large cell neuroendocrine carcinoma (7). Roughly 46%–93% of patients with neuroendocrine tumors develop liver metastasis, which can involve large portions of liver with associated symptoms.

01 febrero 2013

RADIOLOGY. Intraprocedural C-Arm Dual-Phase Cone-Beam CT: Can It Be Used to Predict Short-term Response to TACE with Drug-eluting Beads in Patients with Hepatocellular Carcinoma?

Romaric Loffroy, MD, PhD, , MingDe Lin, PhD, , Gayane Yenokyan, PhD, , Pramod P. Rao, MD, , Nikhil Bhagat, MD, , Niels Noordhoek, PhD, , Alessandro Radaelli, PhD, , Järl Blijd, MSc, , Eleni Liapi, MD, and , Jean-François Geschwind, MD

Introduction: Hepatocellular carcinoma (HCC) is the third most common cause of cancer death worldwide (1). Most patients present with intermediate or advanced disease that is not amenable to curative treatment, and the median survival in this group is 6–8 months (2). Several studies and well-designed randomized trials have shown a positive effect of transcatheter arterial chemoembolization (TACE) on patient outcome and survival (3–11).

01 febrero 2013

RADIOLOGY. Percutaneous Recanalization for Budd-Chiari Syndrome: An 11-year Retrospective Study on Patency and Survival in 177 Chinese Patients from a Single Center

Guohong Han, MD, , Xingshun Qi, MD, , Wei Zhang, MD, , Chuangye He, MD, , Zhanxin Yin, MD, , Jianhong Wang, MD, , Jielai Xia, MD, , Ke Xu, MD, , Wengang Guo, MD, , Jing Niu, MD, , Kaichun Wu, MD, PhD, and , Daiming Fan, MD, PhD

Introduction: Budd-Chiari syndrome (BCS) is characterized by the obstruction of the hepatic venous outflow tract from the level of the small hepatic veins to the level of the termination of the inferior vena cava (IVC) into the right atrium in the absence of cardiac disease, pericardial disease, or sinusoidal obstruction syndrome (1). Given the rarity of this disease, no controlled trials have been performed. Accordingly, the current recommendations for the treatment of primary BCS originate from cohort studies and expert opinions (2). A step-wise therapeutic strategy aimed at minimal invasiveness has been adopted, and this strategy proceeds according to the response to therapy (3). This strategy mainly consists of four steps: (a) medical therapy, such as anticoagulation and diuretics; (b) percutaneous recanalization of hepatic veins and/or the IVC; (c) placement of a transjugular intrahepatic portosystemic shunt (TIPS); and (d) orthotopic liver transplantation. Furthermore, a large case series has demonstrated that anticoagulation and TIPS placement have become the mainstay treatment options for BCS in Western countries (4).

01 febrero 2013

RADIOLOGY. Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: Short- and Intermediate-term Results

João Pisco, MD, PhD, , Luís Campos Pinheiro, MD, PhD, , Tiago Bilhim, MD, PhD, EBIR, , Marisa Duarte, MD, , Hugo Rio Tinto, MD, , Lúcia Fernandes, MD, , Vítor Vaz Santos, MD, PhD, and , António Gouveia Oliveira, MD, PhD

Introduction: The diagnosis of benign prostatic hyperplasia (BPH) may be based on three findings: microscopic detection of prostatic hyperplasia (benign proliferation of the stroma and epithelium on the basis of pathologic specimens); palpable enlargement of the prostate, as detected with clinical or ultrasonographic (US) examination; or the presence of lower urinary tract symptoms, such as higher urinary frequency (particularly at night, termed “nocturia”), urinary urgency, urinary leaking, and decreased, hesitant, interrupted urinary stream. However, it is the clinical findings, particularly those indicated by the severity of the lower urinary tract symptoms, that affect the management of these cases.

01 enero 2014

RADIOLOGY. Active Hemorrhage and Vascular Injuries in Splenic Trauma: Utility of the Arterial Phase in Multidetector CT

Jennifer W. Uyeda, MD, Christina A. LeBedis, MD, David R. Penn, MD, Jorge A. Soto, MD, Stephan W. Anderson, MD

Introduction: The advent of multidetector computed tomography (CT) has proved invaluable in the rapid evaluation of intraabdominal injuries in patients who sustain multiple trauma (1–9). Multidetector CT has high accuracy for detecting hollow- and solid-organ injury in the trauma setting, including the evaluation for traumatic splenic injuries (1–3,8–10). The detection of active splenic hemorrhage and contained vascular injuries is crucial for identifying the need for subsequent direct intervention (eg, surgery or transcatheter embolization) versus conservative, nonsurgical treatment (1–3,6,7,9,11–15).