Interventional Radiological Treatment Research Articles

Assessment of Efficacy and Complications of Endovascular Interventions for Critical Limb Ischemia in Germany: A Nationwide Study.

Endovascular interventional radiological procedures have become the mainstay for the treatment of critical limb ischemia (CLI) due to arterial stenosis or occlusion. Open surgical or endovascular procedures, such as percutaneous transluminal angioplasty (PTA) or stenting can be used as a treatment strategy. The aim is to evaluate the success and major complication rates of interventional radiology treatments for CLI in Germany in 2021, and to compare these results with internationally published data. Data for PTA and stenting in CLI for 2021 was obtained from the quality management system of the German Society of Interventional Radiology (DeGIR). 16 393 PTA procedures, 701 stenting procedures, and 8110combined procedures were documented for 2021. Data was analyzed for technical and clinical success rates, as well as major complication rates documented mainly as major bleeding, distal embolization, and aneurysm formation. PTA had technical and clinical success rates of 96.3 % and 92.33 %, respectively. Stenting had technical and clinical success rates of 98.7 % and 96.15 %, respectively. PTA and stenting combined had success rates of 98.71 % and 96.91 %, respectively. The major complications were mainly: major bleeding (PTA: 0.40 %; stenting: 1.28 %; PTA and stenting: 0.54 %), distal embolization (PTA: 0.48 %; stenting: 1 %; PTA and stenting: 0.96 %), and aneurysm formation (PTA: 0.19 %; stenting: 0.43 %; PTA and stenting: 0.19 %). All procedures showed high technical and clinical success rates, while the complication rates were low. Interventional radiologists in Germany perform effective and safe treatment for CLI, achieving outcomes that tend to surpass internationally published data. · German interventional radiologists provide safe and effective critical limb ischemia treatment.. · Major complications occurred at maximum in 1.28 % of cases.. · Outcomes tend to surpass international data, indicating strong performance..

Retrospective evaluation of interventional radiological treatments for chronic mesenteric ischemia in Germany based on a four-year period of the DeGIR Registry: comparison of outcomes with international quality standards.

Endovascular treatment has emerged as the gold standard for managing chronic mesenteric ischemia (CMI) resulting from arterial stenosis or occlusion. This study aimed to assess the efficacy and complication rates of continuous interventional radiology treatment for CMI in Germany between 2018 and 2021, comparing these findings with international quality standards. Data for CMI therapy with stenting and percutaneous transluminal angioplasty (PTA) was obtained from the quality management system of the German Interventional Radiological Society (DeGIR). A total of 3752 endovascular procedures for CMI performed from 2018 to 2021 were documented (PTA: n = 675; stenting: n = 3077). Data was analyzed for technical and clinical success rates, as well as major complication rates. Overall technical and clinical success rates for PTA and stenting procedures were 92.03 %/85.9 % and 98.76 %/96.62 %, respectively. The most common major complications were: arterial occlusion (PTA: 0.73 %; stenting: 0.63), major bleeding (PTA: 1.05 %; stenting: 0.68 %), aneurysm formation (PTA: 0.29 %; stenting: 0.72 %), stent dislodgment (PTA: 0 %; stenting: 0.06 %), and organ failure (PTA: 0.43 %; stenting: 0.96 %). Technical and clinical success rates were higher, while complication rates were lower than the corresponding threshold recommended by the Society of Interventional Radiology for the percutaneous management of chronic mesenteric ischemia. Treatment of CMI performed by interventional radiologists in Germany is safe and effective during daily and on-call shifts with results exceeding internationally accepted standards. · Treatment of CMI by interventional radiologists in Germany is effective and safe.. · The interventions are safe and effective regardless of whether they are performed during on-call shifts or the daily routine.. · The clinical and technical success rates favorably surpass the thresholds presented by SIR.. · Different major complications occurred in under 1.1 % of CMI interventions..

Emergency diagnoses in the gastrointestinal tract

Gastrointestinal emergencies are afrequent reason for presentation in the emergency department and involve patients of all ages. The patients must undergo an immediate cross-sectional imaging as in many cases the underlying pathology is alife-threatening condition, which often needs surgical or in some cases also interventional radiological treatment. In this overview, the most important differential diagnoses and their characteristics on cross-sectional imaging are presented.

Usefulness of the hybrid technique of interventional radiology and endoscopic treatment for intestinal bleeding after pancreaticoduodenectomy: a case report

Introduction and importance: In endovascular treatment of ruptured pseudoaneurysm after pancreaticoduodenectomy (PD) with gastrointestinal bleeding, treatment for vasospasm of the culprit vessel from haemorrhagic shock and subsequent reperfusion has not been determined before. Case presentation: The authors hereby present you with a case of a 59-year-old man with unknown operative method upon arrival at the Emergecy room and who had hematemesis and collapse 6 months post-PD surgery. Clinical discussion: An initial contrast-enhanced computed tomography (CT) revealed no obvious source of bleeding, so an upper gastrointestinal endoscope was performed. Rebleeding occurred during the examination, and interventional radiology was performed because haemostasis was difficult. Coil embolization was performed for leakage of contrast material from the gastroduodenal artery stump into the gastrointestinal tract. However, because the embolization was uncertain due to vasospasm of the common hepatic artery, endoscopic clipping of the perforation site was also performed to prevent rebleeding due to reperfusion after improvement of vasospasm. A CT scan 5 days later showed reperfusion of the coil-implanted vessel. No rebleeding or hepatic infarction occurred postoperatively. Conclusion: In this case, the haemostasis by coil embolization was uncertain due to the presence of vasospasm, and clipping was used in combination with the procedure to prevent rebleeding.

Interventional radiology treatments for cholangiocarcinoma

Interventional radiology treatments for cholangiocarcinoma

Interventional Radiology and Surgical Treatment Options for Non-Cirrhotic Portal Hypertension

Interventional Radiology and Surgical Treatment Options for Non-Cirrhotic Portal Hypertension

Interventional Radiological Treatment of Orthotopic Heart Transplant Complications

Orthoptic heart transplantation (OHT) is a life-saving procedure that has substantially improved the lives of countless patients since its inception. However, there are several procedure-related complications that require prompt management. Interventional radiology, with its ever-expanding toolkit, is a cornerstone of the multidisciplinary team following post-cardiac transplant patients. Percutaneous, endovascular therapy provides minimally invasive, safe, and effective treatments for immediate and delayed cardiac transplant complications and this paper serves to highlight the various management options interventional radiology can provide for orthoptic heart transplantation complications.

Safety and efficacy of interventional treatment of acute limb ischemia in Germany 2021

PurposeInterventional procedures have become a mainstay in the therapy of acute limb ischemia caused by embolism or arterial thrombosis. Treatment options include pharmacological thrombolysis (PT) and mechanical thrombectomy (MT). The aim of this study was to evaluate success and major complication rates of interventional radiological treatments of arterial embolism and thrombosis in Germany in 2021 and to compare their results with accepted international quality standards.Materials and methodsData for PT and MT for 2021 was obtained from the quality management system of the German interventional radiological society (DeGIR). 2431 PT and 1582 MT procedures were documented for 2021, with 459 combinations of PT and MT. Data was analysed for technical and clinical success rates, as well as major complication rates such as intracranial bleeding, major bleeding, distal embolization, aneurysm formation, organ-failure and cardiac-decompensation.ResultsPT alone had technical and clinical success rate of 90.21% and 81.08%, respectively. MT alone had technical and clinical success rates of 97.41% and 95.39%, respectively. MT&PT had technical and clinical success rates of 91.07% and 84.75%, respectively. Major complications were: distal embolization (PT:2.02%; MT:1.74%; PT&MT:2.61%), major bleeding (PT:0.94%; MT:1.14%; PT&MT:0.87%), aneurysm formation (PT:0.33%;MT: 1.14%;PT&MT: 0%), intracranial bleeding (PT:0.16%;MT:0%;PT&MT:0.22%), cardiac-decompensation (PT:0.21%;MT: 0.06%;PT&MT:0%) and organ-failure (PT:0%;MT:0.06%;PT&MT:0.22%).Technical and clinical success rates were higher, while complication rates were lower than the corresponding threshold recommended by the Society of Interventional Radiology for percutaneous management of acute lower-extremity ischemia.ConclusionTreatment of arterial embolism and thrombosis performed by interventional radiologists in Germany is effective and safe with outcomes exceeding internationally accepted standards.

Outcomes Following Treatment for Carotid Blowout in Head and Neck Cancer Patients.

The aim of the study was to determine outcomes after interventional radiology treatment of carotid blowout. Patients with head and neck cancer and who received interventional radiology treatment for carotid blowout between 2000 and 2022 were included. Pre-treatment, treatment, and post-treatment variables were evaluated. Fourteen patients met inclusion criteria. Eleven patients (78.6%) had a history of radiation. Twelve (85.7%) blowouts occurred within 6 months of recent intervention. Initial treatment was with stenting (n = 9, 64.3%), coil embolization (n = 4, 28.6%), or both (n = 1, 7.1%). Six patients (42.9%) underwent subsequent carotid bypass. Morbidity following treatment included stroke (n = 1) and rebleeding (n = 4). Six-month survival was 57.1%. Of the patients who survived past six months, 5/8 were treated with carotid bypass and coverage. Four patients died of cancer progression, three of rebleeding, and three of medical complications. The majority of carotid blowout occurs within 6 months of surgery or radiation. Many who survive will die of cancer progression or medical illness. Carotid bypass with flap coverage may be a worthwhile treatment for carotid blowout and should be considered as an adjunct to endovascular treatment. 4 Laryngoscope, 134:695-700, 2024.

Combination polypectomy or excisional biopsy with interventional radiology local tumor destruction versus polypectomy or excisional biopsy for colon cancer: A SEER database analysis.

e15657 Background: Colon cancer is one of the most common forms of cancer, affecting millions of individuals worldwide. Despite advances in surgical and systemic therapies, a significant proportion of patients still present with locally advanced or metastatic disease. Interventional radiology has emerged as a crucial tool in the management of colon cancer, offering a number of minimally invasive treatments aimed at locally destroying the tumor. This study aims to assess the effectiveness and prognostic impact of various interventional radiology treatments for colon cancer. Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with primary colon cancer from the cecum to the sigmoid (primary site codes C180-189), including the appendix, diagnosed between 2000-2019. Patients were included if management of the primary tumor included either excisional biopsy, polypectomy, and/or local tumor destruction (LTD) via photodynamic therapy, electrocautery, cryosurgery, or laser ablation (surgical codes 21-24). Variables included for Kaplan-Meier, Chi-square, and Cox Regression analyses were age at diagnosis, sex, race, stage, and surgical management subtype status. Results: A total of 18164 patients were collected from this search of which 775 patients underwent a combination polypectomy or excisional biopsy with LTD, 6997 patients underwent polypectomy alone, 1619 patients underwent excisional biopsy alone, 7959 patients underwent endoscopic polypectomy alone, 814 patients underwent a surgical excision polypectomy alone. On Kaplan-Meier, the combination polypectomy or excisional biopsy with LTD showed better survival than excisional biopsy alone (p < 0.001). The combination treatment showed similar survivability to polypectomy NOS, endoscopy polypectomy alone, and surgical excision polypectomy alone. The one-, three-, and five-year survival rates of combination treatment were 97.0%, 94.7%, and 93.4%, respectively, which is significantly greater than excisional biopsy at all time points (p’s < 0.001) and within 1% of all other treatments at all time points. On Cox regression, no differences in survival were observed between groups. Of note the demographics of older age (p < 0.001), black race (p < 0.001), American Indian/Alaska Native (p = 0.044), regional spread of tumor ( < 0.001), and distant spread of tumor (p < 0.0001) were all associated with worse survival outcomes. Conclusions: Combination polypectomy or excisional biopsy with interventional radiology LTD procedures are associated with improved survival compared to excisional biopsy alone for the treatment of colon cancer. Our results suggest these interventional radiology procedures may be effective additional management options for the management of primary colon tumors.

Polypectomy or excisional biopsy versus combination polypectomy or excisional biopsy with interventional radiology local tumor destruction for rectal cancer: A SEER database analysis.

e15658 Background: Rectal cancer is a common and potentially debilitating form of gastrointestinal cancer. Despite advances in surgical and systemic therapies, a significant proportion of patients present with locally advanced or recurrent disease. Interventional radiology (IR) has emerged as a crucial tool in the management of rectal cancer, offering a number of minimally invasive treatments aimed at locally destroying the tumor. This study aims to evaluate the efficacy and prognostic significance of combining IR treatments with polypectomy or excisional biopsy in the management of rectal cancer, compared to polypectomy or excisional biopsy alone. Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with primary rectal cancer from the cecum to the sigmoid (primary site codes C209), including the appendix, diagnosed between 2000-2019. Patients were included if management of the primary tumor included either excisional biopsy, polypectomy, or local tumor destruction (LTD) via photodynamic therapy, electrocautery, cryosurgery, or laser ablation (surgical codes 21-24). Variables included for statistical analyses were age at diagnosis, sex, race, stage, and surgical management subtype status. Results: A total of 24309 patients were collected from this search of which 1437 patients were selected that had undergone a combination polypectomy or excisional biopsy with LTD, 15005 patients underwent polypectomy alone, 7481 patients underwent excisional biopsy alone, 386 patients underwent curette and fulguration. On Kaplan-Meier, combination treatment showed a worse mean survival than polypectomy alone (p < 0.01). Combination treatment showed better mean survival than excisional biopsy alone ( < 0.001). The combination treatment showed similar survivability to curette and fulguration. The one-, three-, and five-year survival rates of combination treatment were 98.5%, 95.8%, and 94.8%, respectively, which is significantly greater than excisional biopsy at all points but significantly worse than polypectomy alone at all time points (p’s < 0.001). On Cox regression, combination treatment showed no difference in survival to polypectomy alone and curette fulguration. Combination treatment survival was significantly better than excisional biopsy alone (p < 0.001). Additionally, older age (p < 0.001), regional spread of tumor (p < 0.001), and distant spread of tumor (p < 0.0001) were all associated with worse survival outcomes. Conclusions: Combination polypectomy or excisional biopsy with IR LTD procedures are associated with improved survival compared to excisional biopsy alone for the treatment of rectal cancer. Our findings suggest that IR procedures may serve as an effective adjunct treatment option for primary rectal tumor management.

Benign osteogenic tumors

The most commonly benign osteogenic lesions encountered in the clinical practice are Osteoma, Osteoid Osteoma and Osteoblastoma. The last two lesions are usually symptomatic, and the diagnosis follows the research for the cause of pain. The importance of the diagnosis is also related to the possibility of Interventional Radiology treatment that is, nowadays, the gold standard treatment. Osteoma is frequently documented in routine examination performed for multiple clinical reasons but reported as “collateral finding.” However, it is important to recognize this injury due to its high frequency.

Diagnosis of gynecologic malignancy after the treatment of presumed benign fibroid disease with interventional radiology procedures: a retrospective cohort study

To ascertain the finding of future diagnosis of malignancy in women who undergo nonsurgical treatment for uterine fibroid disease with interventional radiology (IR) procedures. Mixed-methods retrospective cohort study. Two tertiary care academic hospitals in Boston, Massachusetts. A total of 491 women who underwent radiologic intervention for fibroids between 2006 and 2016. Uterine artery embolization or high-intensity focused ultrasound ablation. Subsequent surgical interventions and diagnosis of gynecologic malignancy after the IR procedure. During the study period, 491 women underwent treatment of fibroids with IR procedures; follow-up information was available for 346 cases. The mean age was 45.3 ± 4.8 years, and 69.7% were between the ages of 40 and 49 years. Regarding ethnicity, 58.9% of patients were white, and 26.1% were black. The most common symptoms were abnormal uterine bleeding (87%), pelvic pressure (62.3%), and pelvic pain (60.9%). A total of 106 patients underwent subsequent surgical treatment of fibroids. Of the 346 patients who had follow-up, 4 (1.2%) were diagnosed with leiomyosarcoma after their interventional treatment for fibroids. An additional 2 cases of endometrial adenocarcinoma and 1 case of a premalignant lesion of the endometrium were noted. The proportion of patients who went on to be diagnosed with leiomyosarcoma after conservative IR treatments appears to be higher than previously reported. A thorough preprocedural workup and patient counseling regarding the possibility of underlying uterine malignancy should be undertaken.

An overview of interventional radiology techniques for the diagnosis and management of vascular anomalies: Part 1.

Minimally invasive percutaneous and endovascular strategies performed by interventional radiologists have become the mainstays of treatment for vascular anomalies, with improved outcomes, decreased complication rates, and reduced morbidity. The aim of this article is to introduce physicians who care for patients with vascular anomalies to state-of-the-art advancements in interventional radiology (IR) for diagnosis and treatment. Part 1 of this review will focus on sclerotherapy and cryoablation. Part 2 will discuss embolization, endovenous laser ablation, and image-guided percutaneous biopsy. Select vascular anomalies will be discussed as examples to highlight IR diagnostic and/or treatment techniques.

Assessment of the response to systemic treatment of colorectal liver metastases on cross-sectional imaging - a systematic review.

Colorectal cancer (CRC) is one of the most common malignancies in the world. Nowadays many treatments are available to help control CRC, including surgery, radiation therapy, interventional radiology, and drug treatments. A multidisciplinary approach and the role of radiologists is needed to assist the surgeon in the management thanks to emerging technology and strategies. The Response Evaluation Criteria in Solid Tumours (RECIST) has been created to objectify and standardize cancer response assessment. Thus, in this article specific presumptions and practical aspects of evaluating responses according to the RECIST 1.1 are discussed. Furthermore, examples of possible response to systemic treatment of colorectal liver metastases (CRLM), including tumour necrosis, apparent diffusion coefficient (ADC) values, tumour calcification, tumour fibrosis and intratumoural fat deposition observed on cross-sectional imaging, are described. Disappearing liver metastases (DLM) presents a therapeutic dilemma. The optimal management of DLM remains controversial due to the uncertainty of residual microscopic disease and effective long-term outcomes. The article provides an overview of the CRLM phenomenon and current possible assessment methods of the response to systemic treatment.

Comprehensive treatment of patients with gastric variceal bleeding

Gastro-oesophageal varices are the major clinical manifestations of cirrhosis and portal hypertension. Bleeding from gastric varices is usually severe and is associated with higher mortality and a higher risk of rebleeding than from esophageal varices. The management of variceal bleeding is complex, often requiring a multidisciplinary approach involving pharmacological, endoscopic, and radiological interventions. In terms of treatment, three stages can be considered: primary prophylaxis, active bleeding, and secondary prophylaxis. The main goal of primary and secondary prophylaxis is to prevent variceal bleeding. However, active variceal bleeding is a medical emergency that requires prompt intervention to stop it and achieve long-term hemostasis. This review describes the features of pharmacological, endoscopic and interventional radiological prophylactic and treatment options in gastric variceal bleeding. We searched the literature in the MedLine database on the PubMed platform.

A prospective cross-sectional study assessing teaching of interventional radiology across 20 Australian medical schools, endorsed by the Australian Medical Students Association

BackgroundExisting literature from around the world has shown that teaching of Interventional Radiology (IR) to medical students remains suboptimal. Despite calls for improvement at a “grass-roots” level, most IRs find that junior doctors have limited or no knowledge of IR, and thus reduced awareness of potential IR treatments for their patients or contemplating IR as a future career. The aim of this study was to survey current medical students to assess perception of whether a wider variety of medical schools are integrating IR into their curriculum, from universities all across Australia.This was a prospective cross-sectional study of members of the Australian Medical Students Association (AMSA) from across Australia. Students were given a 14-question survey of current university teaching and students’ knowledge of the discipline of IR. The primary outcome was perception of current teaching and knowledge of IR. Secondary outcomes include awareness of technical, clinical, and other duties of IRs.ResultsSurveys were sent in a newsletter and posted on the AMSA Facebook page to their members. 82 responses were received via students from 20 out of 23 Australian medical schools. 61% of students described poor or no knowledge of IR. Teaching of IR was significantly worse than diagnostic radiology (p < 0.001), only 12% suggested that current IR teaching was adequate, and 99% suggested that IR teaching could be improved. Only 11% of students would consider a career in IR.ConclusionsMedical student perception of exposure to IR is poor compared to diagnostic radiology. Better awareness may lead to improved referral patterns for patients and more career interest in IR.

Interventional Radiology in Hepatocellular Carcinoma: Current Status and Looking Ahead

AbstractHepatocellular carcinoma (HCC) is one of the most common cancers worldwide and its incidence is on the rise. Although transplantation and surgical resection remain the definitive curative treatment options, only a minority of patients are eligible for these owing to advanced stage of disease at diagnosis. Over the last two decades, various interventional radiology (IR) therapies such as ablative and transarterial therapies, have come to the forefront of HCC management. IR also plays a role in preoperative management of HCC patients with procedures such as portal vein embolization. The recently updated Barcelona Clinic Liver Cancer (BCLC) staging system for HCC provides a guideline for choosing the optimum treatment modality for individual patients, with IR playing a central role. This review summarizes the different IR treatment options in HCC, including various ablative therapies, Transarterial Chemoembolization (TACE), Transarterial Radioembolization (TARE), Portal Vein embolization, emphasizing patient selection, procedural considerations and response evaluation.

Lipoleiomyomas of the Uterine Cervix: A New Series including the First Recurrent Case and the First Systematic Literature Review

Uterine leiomyomas usually arise from the uterine body (95%), and rarely from the cervix (0.6%) or other urogenital sites. Lipoleiomyomas are benign, uncommon variants of leiomyomas (0.03-0.2%), histologically composed of smooth muscle cells and mature adipocytes; they usually occur in the uterine body and exceptionally in the cervix. We performed the first systematic literature review of cervical lipoleiomyomas (PRISMA guidelines), presenting five new cases. Including our series, thirty-one detailed cases were reported in the literature (mainly in Asia). The age range was 35-74 years, revealing a higher mean age than conventional cervical leiomyomas (46.5 vs. 39.4 years). Patients were usually multiparous (94%), typically complaining of vaginal bleeding (11/31, 36%), pelvic/abdominal pain (10/31, 32%), and/or urinary disturbances (6/31, 19%) 1 week to 10 months before presentation. Clinical examination revealed a pedunculated tumor (48%), or prolapse of ≥1 pelvic organs (16%). Twenty-four (77%) patients underwent total hysterectomy ± additional surgery; simple myomectomy/excision was performed in five (16%) cases. Only one (3%) of our cases recurred 2 years after partial excision; no evidence of disease was found 13 years after recurrence excision. Adipocytes occupied ≤50% of the tumor volume. Hyaline or myxoid changes and cartilaginous metaplasia were uncommon histological findings. Surgically challenging cases or pregnant patients may require expert gynecologists. Interventional radiology or conservative treatments were rarely proposed.

Progress in interventional radiology treatment of pulmonary embolism: A brief review.

Pulmonary embolism represents a common life-threatening condition. Prompt identification and treatment of this pathological condition are mandatory. In cases of massive pulmonary embolism and hemodynamic instability or right heart failure, interventional radiology treatment for pulmonary embolism is emerging as an alternative to medical treatment (systemic thrombolysis) and surgical treatment. Interventional radiology techniques include percutaneous endovascular catheter directed therapies as selective thrombolysis and thrombus aspiration, which can prove useful in cases of failure or infeasibility of medical and surgical approaches.