Abstract Background: Abdominal wall endometriosis (AWE) is a rare form of endometriosis that often results in cyclic abdominal pain. The current treatment algorithm for AWE is not well established. Radiofrequency ablation (RFA) is an emerging technique that shows promise in treating AWE. Objective: This retrospective study aims to evaluate the safety and efficacy of ultrasound (US)-guided RFA for patients with AWE at the Security Forces Hospital in Riyadh, Saudi Arabia, between January 2020 and January 2024. Methods: Forty-two female patients with pathologically confirmed AWE who underwent US-guided RFA were included in the study. Lesions were assessed radiologically before the procedure using abdominal US, contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI). All patients were followed for a minimum of 6 months after the intervention, with MRI used to evaluate lesion response. Treatment efficacy was assessed based on symptom relief, lesion volume reduction, and complication rates during the follow-up period. Results: Patient ages ranged from 28 to 52 years, with a median age of 42 years. All patients had a history of cesarean section and presented with cyclic pain. Preprocedure imaging revealed irregular hypoechoic lesions on US, solid soft-tissue masses on CT, and low signal intensity with heterogeneous enhancement on MRI. Histopathology confirmed the presence of endometrial cells in all cases, with most patients (40.48%) having lesions located below the scar. The majority of patients (95.2%) required only a single session of RFA. The complications included a minor scar wound, occurring in one case (2.4%). Complete radiological resolution was achieved in all patients (100%). Conclusion: This study demonstrates that RFA is a safe and effective treatment for AWE, offering significant symptom relief with minimal complications. Further research is warranted to validate these findings and optimize the treatment protocol.

Abstract Liver abscesses require tailored management based on etiology, comorbidities, and complexity. While conventional treatment involves antibiotics and image-guided percutaneous drainage, refractory cases may need more advanced interventions. This report describes using a 20 Fr large-bore aspiration device (LBAD), typically used for pulmonary embolism, to manage a complex liver abscess in a 43-year-old male. After failing multiple drain exchanges and long-term antibiotics, the LBAD catheter was used under fluoroscopic guidance to aspirate 250–300 mL of necrotic debris, followed by the placement of a 20 Fr drain. The patient showed marked improvement, with normalization of inflammatory markers by week 7 and near-complete resolution of the abscess, enabling a successful multivisceral transplant. This case highlights the potential for repurposing thrombectomy devices for refractory liver abscesses and highlights the need for further studies on their efficacy, safety, and cost-effectiveness in hepatobiliary care.

Abstract Purpose: The management of trauma patients has evolved in recent decades, with endovascular techniques including angiography, embolization, filter placement, and resuscitative balloon occlusion. Few studies have utilized a national trauma database to understand the magnitude of this practice at a national population-based level. Herein, the objective is to understand the utilization and effect of interventional radiology (IR) treatment on hemodynamically unstable trauma patients in the National Trauma Data Bank (NTDB). Methods: The NTDB was queried from 2013 to 2023 for patients who received packed red blood cells or whole blood within 4 h after arrival. Patients with trauma to the abdomen, extremities, and thorax were included. IR intervention was identified as those who underwent angioembolization and angiography with stenting, while angiography only and no angiography were considered “no IR intervention.” Multivariable Cox proportional hazard regression was conducted to assess the effect of IR intervention in the cohort, and subgroup analysis was done in the setting of nonoperative (nonsurgical) and operative (surgical) management. Results: Totally 322,205 patients were identified in the database; 28,409 (8.8%) underwent IR intervention. Most patients were nonoperative with no IR intervention ( n = 150,374; 47%), while 122,551 (38.5%) underwent surgical intervention without IR intervention, and 27,478 (8.6%) underwent IR intervention without surgical intervention. Overall, IR intervention was associated with a lower risk of mortality compared to no intervention (hazard ratio [HR]: 0.87; P < 0.001). Subgroup analysis among nonsurgical patients demonstrated that IR intervention was associated with a lower risk of mortality (HR: 0.70; P < 0.001). Among surgical patients, IR intervention was associated with a similar risk of mortality (HR: 0.96; P = 0.20). Conclusion: IR was associated with lower mortality risk compared to no IR intervention. This result remained with propensity-weighted analysis for nonoperative patients and suggests the overall positive impact of IR-related embolization and/or stenting. This study demonstrated that IR intervention may be beneficial for hemorrhaging patients and that interventional radiologists must be an integral part of the discussion regarding trauma protocols to support a multidisciplinary approach.

Abstract Background: Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms, affecting quality of life (QoL) in ageing men. While transurethral resection of the prostate (TURP) remains the standard treatment, its complications have spurred interest in less invasive alternatives. Transperineal laser ablation (TPLA) has emerged as a promising option. This systematic review and meta-analysis evaluate the safety and efficacy of TPLA for BPH. Methods: A systematic search of PubMed, Scopus, Cochrane CENTRAL, Web of Science, and Ovid was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies were either prospective or retrospective, involving adult males with BPH treated through TPLA. Outcomes assessed included Qmax, postvoid residual (PVR), prostate volume, International Prostate Symptom Score (IPSS), sexual function, and QoL. The meta-analysis was performed using MedCalc software, with heterogeneity and sensitivity analyses. Results: Nineteen studies (sample sizes 20–160), primarily from Italy. All used transperineal diode laser ablation, most of them done under local anesthesia. TPLA significantly improved urinary outcomes: At 6–12 months, there was a significant reduction in the IPSS with a mean difference of −12.78. Qmax increased by a mean of −5.33 mL/s. PVR decreased by 59.8 mL. QoL scores also improved (mean difference: −2.61). While prostate volume was reduced with a mean decrease of 17.4 mL. Sexual function was largely preserved; no statistically significant change in erectile function, as measured by the International Index of Erectile Function-5 score, at any follow-up period ( P = 0.112 at 6–12 months). While pooled Male Sexual Health Questionnaire–Ejaculatory Dysfunction scores improved, the change from baseline did not reach statistical significance under our random-effects model ( P = 0.092), suggesting a strong tendency toward preservation rather than enhancement of ejaculatory function. Mainly, low-grade complications were reported (Clavien–Dindo Grade I-II). Conclusion: TPLA appears to be an effective and safe minimally invasive treatment for BPH, clinically improving urinary symptoms and QoL, and critically preserving both erectile and ejaculatory function. Further high-quality, long-term trials are recommended.

Abstract Objective: Pulmonary embolism (PE) represents a critical medical emergency characterized by the obstruction of pulmonary arteries due to thrombus formation. Timely recognition and management of this condition are crucial for enhancing patient outcomes. Methods: The establishment of the PE response team (PERT) has facilitated the incorporation of multidisciplinary expertise to provide prompt and coordinated interventions aimed at improving clinical outcomes. This review delineates the development and implementation of PERT at Prince Sultan Military Medical City and Prince Sultan Cardiac Center in Riyadh, Saudi Arabia, and assesses its impact on patient outcomes, treatment efficiency, and mortality rates. Results: Between January 1 and June 30, 2024, the PERT protocol was activated in 50 cases, with advanced therapeutic interventions being administered in 20 (40%) of these instances. The mortality rate for patients classified as having intermediate-high to high-risk PE was recorded at 10%. The mean time for treatment execution was 2.2 ± 1.2 h. Notably, there were four reported major bleeding events: three of these were linked to systemic thrombolysis, while one occurred in a patient receiving extracorporeal membrane oxygenation. The median length of hospital stay associated with PERT interventions was 3 (±2) days. Conclusion: The implementation of PERT has significantly enhanced the utilization of advanced therapeutic strategies for patients with intermediate- to high-risk PE and has been associated with a marked reduction in mortality rates.

Abstract Introduction: Interventional radiology (IR) is a rapidly evolving specialty that involves minimally invasive diagnostic and therapeutic procedures. In the Kingdom of Saudi Arabia, integration of IR into multidisciplinary care continues to expand; however, physicians’ knowledge and perceptions of IR remain underexplored. This study is the first national survey evaluating IR knowledge and perceptions among practicing physicians from multiple clinical specialties in the KSA. Methods: A cross-sectional study was conducted among 382 physicians across KSA using a structured 14-item survey evaluating demographics, IR knowledge, and perceptions. The questionnaire was reviewed by two interventional radiologists for content accuracy, and participants were recruited through healthcare-related social media channels. Data analysis included descriptive statistics and Chi-square testing ( P < 0.05) using SPSS version 29.0.0. Results: Of 382 physicians, 69.9% were aged <30 years, 62.0% were male, and 70.2% had <5 years of clinical experience. Correct knowledge of the IR training pathway (4 + 2 years) was identified by 62.6% of respondents. Most recognized IR as distinct from vascular surgery (87.7%). Self-rated knowledge was reported as poor (26.4%), adequate (49.2%), or good/excellent (24.4%). Greater interest in further IR education was significantly associated with older age ( P = 0.027) and >10 years of practice ( P = 0.047). Conclusion: Physicians in KSA generally acknowledge IR as a distinct and valuable specialty; however, notable gaps persist in training pathway awareness and perceived knowledge. The high demand for additional IR education supports the need for targeted initiatives, enhanced clinical exposure, and multidisciplinary educational strategies nationwide.

Abstract Background: Surgical intervention is usually required to treat symptomatic bile duct stones (BDS) in patients after failed endoscopic retrograde cholangio-pancreatography (ERCP) or in the presence of biliary-enteric anastomosis. Percutaneous transhepatic cholangioscopy (PTCS) is a promising non-surgical intervention, especially for surgically unfit patients. The study aim was to report our experience of Interventional Radiology (IR) led PTCS and lithotripsy for treatment of BDS in a single centre. Patients and Methods: Retrospective review of consecutive patients who underwent PTCS and lithotripsy for BDS between March 2021 and December 2023 in single UK tertiary hepatobiliary centre. Results: Eight patients underwent PTCS during the study period. Indications for PTCS were either failed ERCP ( N = 3) or ERCP was inappropriate due to previous surgery ( N = 5). Duct clearance was possible by the index PTCS and lithotripsy procedure and confirmed on follow-up imaging in 6 patients (75%). Two patients underwent duct clearance but had residual stones on follow-up imaging, one of whom had successful duct clearance after repeat PTCS. The remaining patient was asymptomatic and did not require any further intervention. There were no procedural complications. Conclusion: IR led PTCS and lithotripsy for the clearance of biliary stones is safe and effective and can be utilised in cases where the standard of care cannot be applied.

Abstract The human body relies on an intricate network of blood vessels to transport oxygen and nutrients throughout the system. Occasionally, errors during embryonic development lead to the creation of vascular malformations (VMs), which are abnormal clusters of blood vessels. These malformations can present in various forms and affect different areas of the body. A thorough understanding of the origins and characteristics of VMs is vital for accurate diagnosis and effective treatment. This article investigates VMs by exploring their classification according to blood flow velocity, the diagnostic methods used to identify them, and the treatment options tailored to specific VM types. We will examine the underlying mechanisms of these developmental anomalies, their categorization, and the ways in which advancements in medical science are enhancing the outcomes for patients affected by VMs.

Abstract Objectives: This study aims to assess OB-GYN physicians’ knowledge of the minimally invasive interventions of the uterine artery embolization (UAE) procedure as a treatment option in multiple hospitals in Saudi Arabia and to highlight the obstacles that can affect OB-GYN physicians’ recommendation of UAE to their patients. Methods: A total of 443 OB-GYN physicians with diverse levels of experience in Saudi Arabia participated in this study. They completed a self-administered online questionnaire that assessed their knowledge of UAE as a treatment option for different OB-GYN-related conditions. Participants’ demographic data and knowledge of UAE clinical indications, contraindications, and complications were collected. In addition, participants were asked to express their views on the challenges associated with recommending UAE in an open-ended question. Results: Among the participants, 48.5% had <5 years of experience, and 68.2% were females. A high percentage of participants reported knowledge of UAE indications (95.3%), contraindications (84.2%), and complications (86.7%). However, when asked about each specific indication, contraindication, and complication individually, responses varied widely, with knowledge levels ranging from 56.4% to 90.3% across different items. Notably, physicians with over 10 years of experience had significantly higher scores compared to those with <5 years (7.6 vs. 4.9, P < 0.001). The most frequently reported obstacle to recommending UAE was the limited availability of interventional radiology services (26 out of 55 respondents). Conclusion: Our results showed that the lack of interventional radiology (IR) service is the main obstacle to recommending UAE; thus, recruiting more interventional radiologists and enhancing the IR facilities are crucial.