Interventional Radiology Therapy Research Articles

Simplifying Stem Cell Therapy for IRs: Exploring New Horizons in Interventional Radiology and Cell Therapy

AbstractThe effective treatment of various diseases requires not only medications but also precise delivery methods to the body and specific organs. In this regard, radiology plays a crucial role, acting as the eyes of physicians. In contrast, interventional radiology serves as its hands, acting as one of the most effective drug delivery systems. Among interventional radiology disciplines, arterial drug delivery through arteries holds paramount importance as organs primarily receive nourishment directly from them. Furthermore, regenerative medicine is a burgeoning field dedicated to repairing diverse body tissues without relying on pharmaceutical drugs. Stem cells, inherent in various parts of our bodies, are vital for tissue regeneration and reconstruction. Depending on the treatment approach, stem cells can be sourced from the patient's body (autologous) or another individual (allogeneic). There exist various types of stem cells across species, with regenerative properties observed in animals and even plants. However, targeted cell therapy is preferred over systematic injections throughout the body for better efficacy. This article aims to familiarize interventionalists with stem cells and provide them with a clear and helpful explanation of their functions, mechanisms of action, different sources, and other relevant aspects. This will help them select the most appropriate cells for their therapeutic purposes. By comprehensively understanding the significance of stem cells in interventional radiology, we can implement optimal methodologies to address diverse medical conditions efficiently.

A299 ACUTE TUMOUR RUPTURE POST-TRANSARTERIAL CHEMOEMBOLIZATION IN A PATIENT WITH HEPATOCELLULAR CARCINOMA

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, with increasing worldwide incidence. Transarterial chemoembolization (TACE) is an interventional radiological (IR) therapy used largely in intermediate stage HCC, which can provide successful bridge or downstaging to liver transplantation and increased survival rates. Tumour rupture is a very rare complication of TACE, with an estimated incidence of 0.68%. Potential risk factors include tumour size ampersand:003E 10 cm, and location of lesions in the right lobe or near the liver capsule. However, the pathophysiology of post-TACE tumour rupture is still not fully understood. Aims We aim to describe a case of HCC tumour rupture that occurred in the first 30 hours post-TACE. We also aim to highlight the extent of multiorgan ischemia associated with this tumour-related arterial bleed. Methods A PubMed literature review was done to ensure that post-TACE tumour rupture was a rare and sparsely reported event. Subsequently, inpatient notes, laboratory and imaging data were obtained from the patient's medical record in an anonymized manner. Results A 66-year-old male with alcohol-related liver cirrhosis (MELDNa 7; Child-Pugh Class A) was diagnosed with a 3.3 cm HCC, spanning segments 5 and 8. Six months later, after multidisciplinary discussion, he underwent successful elective TACE of a segment 8 artery that was supplying the HCC, as a bridge to liver transplantation. The next day, he developed diffuse abdominal pain, emesis, tachycardia, and abdominal firmness and tenderness. Labs showed a 45 g/L drop in hemoglobin (121 g/L to 76 g/L), leukocytosis (27.0 x109/L), and an elevated lactate (4.4 mmol/L). Computed tomography (CT) scan confirmed tumour rupture, with moderate-to-large hemoperitoneum with active bleeding from the embolized region of the HCC, and associated gas. Emergent IR-guided embolization was performed to the bleeding segment 8 artery. CT scan two days later revealed interval ischemic infarction of the spleen, pancreatic tail, and stomach. This widespread ischemia was suspected to be due to hypovolemic hypoperfusion vs. post-TACE embolic phenomena. Aggressive supportive measures, antibiotics, and anticoagulation were implemented. Due to tumour rupture, the patient was deemed no longer a suitable candidate for liver transplantation. Futility of definitive management was discussed, and the patient opted for medical care without resuscitation. After optimization of nutritional and physical functioning parameters, he was discharged home with medical management for pain and ascites. Conclusions Post-TACE tumour rupture is a rare occurrence for which the pathophysiology is not fully understood. This case provides an important reminder of this potential adverse event. Early detection and management are imperative to facilitating a favourable outcome in this life-threatening condition. Funding Agencies None

Interventional Radiology Locoregional Therapies for Intrahepatic Cholangiocarcinoma.

Surgical resection remains the cornerstone of curative treatment for intrahepatic cholangiocarcinoma (iCCA), but this option is only available to a small percentage of patients. For patients with unresectable iCCA, systemic therapy with gemcitabine and platinum-based agents represents the mainstay of treatment; however, the armamentarium has grown to include targeted molecular therapies (e.g., FGFR2 inhibitors), use of adjuvant therapy, liver transplantation in select cases, immunotherapy, and locoregional liver-directed therapies. Despite advances, iCCA remains a challenge due to the advanced stage of many patients at diagnosis. Furthermore, given the improving options for systemic therapy and the fact that the majority of iCCA patients succumb to disease progression in the liver, the role of locoregional therapies has increased. This review will focus on the expanding role of interventional radiology and liver-directed therapies in the treatment of iCCA.

Factors associated with the need for long-term total parenteral nutrition in survivors of acute superior mesenteric artery occlusion.

Acute superior mesenteric artery (SMA) occlusion is an uncommon condition associated with high mortality. If extensive bowel resection is performed for patients with acute SMA occlusion and the patient survives, long-term total parenteral nutrition (TPN) may be needed due to short bowel syndrome. This study examined factors associated with the need for long-term TPN after the treatment of acute SMA occlusion. We retrospectively analyzed 78 patients with acute SMA occlusion. Patients were abstracted from a Japanese database from institutions with at least 10 patients with acute SMA occlusive disease from January 2015 through December 2020 RESULTS: Among the initial cohort there were 41/78 survivors. Of these, 14/41 (34%) required permanent TPN who were compared with those who did not require long-term TPN (27/41, 66%). Compared to patients in the non-TPN group, those in the TPN group had significantly shorter remaining small intestine (90.7 cm vs. 218 cm, P<0.01), more patients with time from onset to intervention >6 hours (P=0.02), pneumatosis intestinalis on enhanced computed tomography scan (P=0.04), ascites (Odds Ratio 11.6, P<0.01), and a positive smaller superior mesenteric vein sign (P= 0.03). These were considered significant risk factors for needing long-term TPN. Age, gender, underlying disease, presence of peritoneal sign, presence of shock requiring vasopressors, site of obstruction (proximal vs. distal), and initial treatment (surgery vs. interventional radiology vs. thrombolytic therapy) were not significantly different between the two groups. Long-term TPN was significantly associated with longer hospital stay (52 vs. 35 days, P=0.04). Multivariate analysis identified the presence of ascites as an independent risk factor for needing long-term TPN. The need for permanent TPN after treatment of acute SMA occlusion is significantly associated with longer hospital stay, longer time to intervention, and characteristic imaging findings (pneumatosis intestinalis, ascites, Smaller SMV sign). Ascites is an independent risk factor. III.

Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction.

Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

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.

A CASE REPORT ON RIGHT SIDE CORTICO- CAVERNOUS FISTULA

INTRODUCTION: The cortico-cavernous fistula is uncommon and uncommonly uncommon. A cortico-cavernous fistula is characterized by an abnormal vascular connection between the internal or external carotid arteries and the venous channels of the cavernous sinus. If left untreated, it might cause additional complications such as intracerebral hematoma, subarachnoid hemorrhage, epistaxis, and otorrhagia. Secondary cortico-cavernous fistula cause glaucoma.CASE PRESENTATION: The interventional radiology unit of the tertiary care hospital in Wardha received an admission of a 22-year-old man. He arrived complaining of a 15-day-old facial and nasal bone injury, which had left him with suitable eye redness, pain, and edema in addition to a headache. Additionally, he was traumatized by a vehicle accident. There is no history of hematemesis, nausea, or vomiting. There is no history of a cold, a cough, or a concussion. Such illnesses as diabetes mellitus, hypertension, T.B., and asthma were absent. There was a physical examination. Save for the eye, other physical characteristics are typical. Redness and swelling are seen in the right eye. Above the conjunctiva, is a thick, red blood vessel. The S1 and S2 noises were usual. On the abdomen, there are no scars or enlargements.THERAPEUTIC MANAGEMENT: The patient was admitted for interventional radiology therapy of a cortico-cavernous fistula. Vital readings for the patient, like blood pressure, were 120/80. The measurements were 37 °C temperature, 75 b/m pulse, and 15 b/m respiration rate. After the patient's accident-related medical history was obtained, an evaluation of the patient's physical condition, blood work, a C.T. Scan, an MRI, an X-ray, and an E.C.G was evaluated. The patient had received antibiotics, antiplatelet medications, antiemetics, antacids, and analgesics. The patient had received antibiotics, antiplatelet drugs, antiemetics, antacids, and painkillers. The patient has been advised to undergo cortico-cavernous fistula embolization surgery.

An overview of end arterial interventional radiology infectious complications

Over 7 million patients worldwide have end arterial interventional radiology procedures (EAIRP). These procedures are now a standard tool in vascular surgery. On the other hand, little is known about the infections connected to these medical procedures. It's possible to underestimate the prevalence and adverse effects of infectious complications (IC) after EAIRP. Our objective is to calculate the incidence and outcome trends across the country for EAIRP. The PMSI's database is instantly accessible and has been amassed over time. The Common Classification of Medical Acts codes represents the homogeneous population to evaluate endovascular interventional radiology therapy. Through various stages of the study, this protocol will call for proficiency in medicine, epidemiology, statistics, data processing, and procedures.

Placenta Accreta Spectrum Part I: anesthesia considerations based on an extended review of the literature.

"Placenta Accreta Spectrum" (PAS) describes abnormal placental adherence to the uterine wall without spontaneous separation at delivery. Though relatively rare, PAS presents a particular challenge to anesthesiologists, asit is associated with massive peripartum hemorrhage and high maternal morbidity and mortality. Standardized evidence-based PAS management strategies are currently evolving and emphasize: "PAS centers of excellence", multidisciplinary teams, novel diagnostics/pharmaceuticals (especially regarding hemostasis, hemostatic agents, point-of-care diagnostics), and novel operative/interventional approaches (expectant management, balloon occlusion, embolization). Though available data are heterogeneous, these developments affect anesthetic management and must be considered in planed anesthetic approaches. This two-part review provides a critical overview of the current evidence and offers structured evidence-based recommendations to help anesthesiologists improve outcomes for women with PAS. This first partdiscusses PAS management in centers of excellence, multidisciplinary care team, anesthetic approach and monitoring, surgical approaches, patient safety checklists, temperature management, interventional radiology, postoperative care and pain therapy. The diagnosis and treatment of hemostatic disturbances and preoperative prepartum anemia, blood loss, transfusion management and postpartum venous thromboembolism will be addressed in the second part of this series.

Pregnancy and medical radiation

IntroductionA non-negligible number of pregnant patients and radiation professionals are exposed to ionizing radiation for diagnostic and therapeutic purposes, each year. The lack or even the wrong information results in excessive stress and, in many cases unjustified termination of the pregnancy. Materials and methodsInternational Commission on Radiological Protection (ICRP) Publication 84 concerns the management of pregnant patients as well as pregnant workers in medical establishments where ionizing radiation is used. Based on the above report and the recent literature, this work discusses how to deal with these matters which are: Medically necessary radiation exposure of a pregnant woman, radiation-induced malformations, pre-conception radiation, handling of pregnant or probably pregnant patient in the hospital, absorbed dose to the fetus in Conventional and Interventional Radiology, Nuclear Medicine and Radiation Therapy, dose limits for pregnant workers, research involving pregnant women, termination of pregnancy. Results & discussionWe have shown that, the vast majority of conventional radiographic procedures and the majority of diagnostic procedures in nuclear medicine are at doses much lower than the exposure associated with fetal harm. In contrast, Radiation Therapy, multiple CT scans, certain therapies in nuclear medicine, and Invasive Radiology can potentially cause serious damage to the fetus. Termination of pregnancy depends on many medical, psychological and social factors.Specific goals of this work are to outline and evaluate the risks to the conceptus when exposed to radiodiagnostic and radiotherapeutic procedures during the various stages of pregnancy, to manage and evaluate radiation doses, to recommend means to control, and to evaluate communication issues with the pregnant patients.

MRI-Guided Intraluminal HDR Brachytherapy for Inoperable Malignant Biliary Tract Obstruction

Aim: Malignant biliary tract obstruction (MBTO) leads to abdominal pain, jaundice, poor quality of life and portends a poor prognosis. Management of MBTO is a significant therapeutic challenge given that treatment with chemotherapy or radiotherapy has limited utility and percutaneous biliary drainage or stent insertion provides only transient symptomatic relief. Intraluminal HDR brachytherapy via catheters inserted percutaneously at the time of stent insertion can be effective in the management of inoperable MBTO. Here, we describe the workflow developed within our department for simulation and treatment using an intraluminal brachytherapy technique. Process: Delivery of bile duct brachytherapy requires the participation of multiple disciplines including interventional radiology (IR), medical physics, radiation oncology (RO) and radiation therapy with careful coordination of numerous tasks. A drain/stent and 1-2 treatment catheters are inserted into the patient's bile ducts by IR before the CT and MR simulation (sim). During the CT sim, multiple surview and low dose helical scans are acquired to verify the treatment catheter position and adjustments are made by the RO as needed. Once the position is finalized, a planning CT scan is done with IV contrast and the patient in voluntary breath hold. Then, the CT and MR sim images are fused. The CT is used to digitize the brachytherapy source path, while the MR is used for target and organs at risk delineation. Treatment is delivered 1-2 days after sim, with 15-25 Gy in 3-5 fractions using an Ir-192 HDR source. Radiographs are taken to confirm catheter position prior to each treatment. Benefits/Challenges: Brachytherapy can be used to treat the tumor at the same time as placement of a stent/drain, thus providing both symptom management and disease control. Although the patient is admitted for the IR procedure, the actual brachytherapy treatment is done on an outpatient basis with no anesthesia, thus treatment does not require significant time or resources in the brachytherapy suite. Patients often present with biliary obstruction emergently and stent/drain placement is booked urgently in IR with little notice to the radiotherapy department. The tight time line makes it difficult to facilitate communication between the multidisciplinary team, prepare staff, assemble supplies, and coordinate subsequent appointments. The CT sim process continues to evolve as new issues are identified with each patient. Variations in catheter/stent placement is a potential challenge and 2/8 patients have required reinsertion of angio-sheath by IR after problems were discovered during the CT sim. MR sim is not always possible depending on nature of inserted material (i.e. metallic stent or drainage sheath). Treatment catheters must be secured in place and covered with a dressing between appointments to prevent damage, change in position or obstruction. Patient education and cooperation is crucial to ensure proper care. Impact/Outcomes: In April 2021, our institution became the first in Canada to offer MRI-guided brachytherapy treatment for patients with inoperable MBTO. As of Jan 2022, 8 patients have been treated using this protocol. With each subsequent case, the time required for treatment delivery has decreased from 1 hour to 30 minutes per fraction and sim processes optimized. This treatment option has potential to improve the quality of life in patients with minimal therapeutic options.

The role of a novel self-expanding metal stent in variceal bleeding: a multicenter Australian and New Zealand experience.

Background and study aims Refractory variceal bleeding is associated with high mortality in patients with chronic liver disease. A fully-covered self-expanding metal stent (SEMS) has been reported to have excellent rates of technical success and initial bleeding control; however, studies to date are small and limited to Europe and Asia. Our aim was to evaluate the efficacy and safety of this SEMS for control of refractory variceal bleeding (VB). Patients and methods A retrospective analysis was undertaken of all patients who received the SX-ELLA Danis SEMS for management of VB at 9 tertiary centers across Australia and New Zealand. A total of 32 SEMS had been deployed in 30 patients (median age 53.3). Results Technical success of SEMS placement was achieved in 100 % of cases, resulting in immediate control of bleeding across 31 of 32 cases (96.9 %). Re-bleeding with SEMS in situ occurred in three of 32 cases (9.4 %). Mean SEMS in-dwelling time was 6.4 days. Delayed SEMS migration occurred in 6.3 % of cases. Interventional radiological therapy for management of varices within 6 weeks was performed in 12 of 30 patients (40 %). Death with SEMS in situ occurred in seven of 30 patients (23.3 %). Seven-day bleeding-related mortality was 16.7 %, 14-day mortality 23.3 %, and 6-week mortality 33.3 %. Three of 30 patients (10 %) received orthotopic liver transplantation following SEMS insertion, including two patients within 6 weeks. Conclusions SX-Danis Ella SEMS is highly effective for immediate control of refractory VB and bridging to definitive therapy because it has excellent technical success rates, appears to be relatively easy to use, and has low rates of serious adverse events.

The Impact of a Multifaceted Pharmacist-Led Antimicrobial Stewardship Program on Antibiotic Use: Evidence From a Quasi-Experimental Study in the Department of Vascular and Interventional Radiology in a Chinese Tertiary Hospital.

Objective: The objective of the study was to assess the impact of multifaceted clinical pharmacist-led antimicrobial stewardship (AMS) program on the rational use of antibiotics for patients who receive vascular and interventional radiology therapies. Methods: A quasi-experimental retrospective intervention design with a comparison group was applied to the practice of antibiotic use in the department of vascular and interventional radiology in a Chinese tertiary hospital. We used difference-in-differences (DID) analysis to compare outcomes before and after the AMS intervention between the intervention group and control group, to determine whether intervention would lead to changes in irrationality of antibiotic prescribing, antibiotic utilization, cost of antibiotics, and length of hospital stay. Results: The DID results showed that the intervention group was associated with a reduction in the average consumption of antibiotics (p = 0.017) and cost of antibiotics (p = 0.006) and cost per defined daily dose (DDD) (p = 0.000). There were no significant differences in the mean change of total costs and length of stay between the two groups (p > 0.05). The average inappropriate score of perioperative antimicrobial prophylaxis in the intervention group declined by 0.23, while it decreased by 0.02 in the control group [0.21 (95% CI, −0.271 to −0.143); p = 0.000]. The average inappropriate score of non-surgical antimicrobial prophylaxis in the intervention group declined by 0.14, while it increased by 0.02 in the control group [0.16 (95% CI, −0.288 to −0.035); p = 0.010]. The average inappropriate score of the therapeutic use of antibiotics in the intervention group declined by 0.07, while it decreased by 0.01 in the control group [0.06 (95% CI, −0.115 to −0.022); p = 0.003]. Conclusions: This study provides evidence that implementation of AMS interventions was associated with a marked reduction of antibiotic use, cost of antibiotics, and irrationality of antibiotic prescribing in China.

Novel score for predicting early emergency endovascular therapy in trauma care using logistic LASSO regression.

AimTo support decision‐making for early interventional radiology, this study aimed to derive and validate a novel and simple scoring system for predicting the necessity of interventional radiology therapies in trauma patients.MethodsThis retrospective study used data derived from the medical records of patients with severe traumatic injuries treated at a tertiary‐level emergency institution. The score was derived from 168 patients treated between April 2015 and October 2016 and validated using data from 68 patients treated between November 2016 and July 2017. Logistic “least absolute shrinkage and selection operator (LASSO)” regression was used to select predictors. In order to compose the score, odds ratios derived from the logistic model were simplified to integer score coefficients. The score was evaluated using the area under the receiver operating characteristic curve. The best cut‐off point for the score was determined using Youden’s index, and sensitivity and specificity were calculated.ResultsThe derived score comprised three predictors (systolic blood pressure, positive findings in abdominal ultrasound assessment, and pelvic fracture) and ranged from 0 to 30. On validation, the area under the receiver operating characteristic curve for the score was 0.86 (95% confidence interval, 0.64–1.00). The sensitivity and specificity were 80% and 89%, respectively, with a cut‐off point of 3.ConclusionThis simple score, requiring variables obtainable immediately after hospital arrival, could aid in facilitating early interventional radiology team activation.

Screening for portopulmonary hypertension using computed tomography-based measurements of the main pulmonary artery and ascending aorta diameters in patients with portal hypertension.

This study aimed to demonstrate the feasibility of identifying candidates of portopulmonary hypertension (PoPH) from general portal hypertension patients based on chest computed tomography (CT) results. One hundred and thirty patients with portal hypertension who had undergone interventional radiology therapies at our hospital between August 2011 and July 2021 were included, and preoperative clinical data were collected. Suspicious PoPH was defined as main pulmonary artery diameter (mPA-D)≥29mm or the ratio of mPA-D to ascending aorta diameter (mPA-D/aAo-D)≥1.0, and probable PoPH as mPA-D≥33mm based on the chest CT. Prevalence of suspicious and probable PoPH was evaluated, and the differences in clinical characteristics of each population were compared. Overall, 29 (22.3%) and 5 (3.8%) patients were categorized as suspicious and probable PoPH, respectively. Univariate analyses revealed that female sex, higher shortest diameter of inferior vena cava, presence of portosystemic shunts ≥5mm, and lower blood urea nitrogen levels were significantly associated with suspicious PoPH (p<0.05). Multivariate analyses identified all four factors as significantly independent determinants of suspicious PoPH (p<0.05). In addition, among the population of suspicious PoPH, there were significant differences in seven parameters, including total bilirubin levels and spleen volume between patients with and without probable PoPH (p<0.05). However, no significant independent indicators of probable PoPH were found. CT-based measurements of mPA-D and mPA-D/aAo-D have the potential to screen patients with suspicious PoPH in clinical practice focused on portal hypertension.

BRAZO ROBÓTICO ARTICULADO PARA ASISTENCIA EN RADIOLOGÍA INTERVENCIONISTA

Objectives: Robotic technology has helped medicine to reduce exposure time and offer greater efficiency and precision in surgical interventions. The goal of using an articulated robotic arm for X-ray (Rx) guided minimally invasive surgery and interventional assistance is to reduce direct and secondary radiation on physicians. The use of a collaborative robotic arm (COBOT) that replaces the operating arm of the surgeon-interventionist physician to avoid exposure to X-rays is described. Methods: The COBOT has a remote-controlled electronic gripper and includes a special needle holder made using 3D printing technology; This holds the interventional instrument, needles, and other surgical elements. The instrument-loaded forceps are oriented and progressed toward intracorporeal therapeutic target points used in interventional radiology and radiation therapy procedures, the COBOT boasts operational precision. Results: Its operation was verified by simulating the interventional action in models in animal tissue, and experimental surgery laboratory. Conclusions: It is concluded that the robot arm can perform assistance functions in radiological and stereotaxic neuroradiological interventionism with a good level of precision, reducing the doctor's exposure to X-rays. Keywords: Robotics, X-Rays, Radiology, Interventional, Robotic Surgical Procedures (Source: MeSH NLM)

Management of Acute Portal Vein Thrombosis With Serial Mechanical Thrombectomy and tPA in a Pediatric Liver Transplant Recipient: A Case Report

Acute portal vein thrombosis is a major cause of fulminant allograft failure in pediatric liver transplantation. Timely intervention is critical to save the graft and patient. Serial interventional radiologic management of this condition is scarcely reported in the literature. A recently transplanted 17-year-old male presented to the emergency department with abdominal pain. Rising liver enzymes prompted discovery of a diffuse portal thrombus, which precipitated fulminant liver failure. The adolescent developed respiratory failure, vasodilatory shock, acute kidney injury, and hepatic encephalopathy, complicating treatment. Multiple interventions attempted to clear the thrombus, including interventional radiologic and medical therapies. Uniquely, a continuous infusion catheter was placed at the thrombosis, delivering local tissue plasminogen activator during a 5-day period. Upon thrombus clearance, the patient made a full recovery with no complications during 12 months of follow-up. When used as a component of multidisciplinary management, continuous locally directed tissue plasminogen activator may be a useful tool for clearance of persistent portal vein thrombosis.

A Case of Human Immunodeficiency Virus-Positive Patient Diagnosed during the Treatment of Right Internal Iliac Pseudoaneurysm.

Isolated internal iliac artery aneurysms are rare, and there are no reports of human immunodeficiency virus (HIV)-related vasculitis in Japan. We report our experience with a 51-year-old man diagnosed with acquired immunodeficiency syndrome, discovered during the postoperative course when the patient exhibited remittent fever and susceptibility to infection after emergency interventional radiology therapy for a right isolated internal iliac artery aneurysm. The patient had positive treponema pallidum particle agglutination test result before admission, and tests for sexually transmitted disease showed positive results for HIV H-1 antibodies. The repeated fevers were attributed to HIV infection-related susceptibility.

Multicenter Evaluation of Cine Angiography and Digital Subtraction Angiography Dose Rate for Various Angiography Programs: Comparison with Fluoroscopic Dose Rate

We conducted a nationwide multicenter survey of various interventional radiology (IVR) procedures. Data were collected from 385 X-ray systems in 126 institutions, including 432 cine programs and 380 digital subtraction angiography (DSA) programs for diagnostic catheterization, percutaneous coronary intervention (PCI), ablation, transcatheter aortic valve implantation (TAVI), neurologic IVR, thorax IVR, abdominal IVR, and endovascular therapy (EVT). Fluoroscopic and cine dose rates were 10.1 mGy/min and 110.7 mGy/min, respectively, whereas for DSA programs, the median fluoroscopic and DSA dose rates were 8.0 mGy/min and 224.8 mGy/min, respectively. The DSA dose rate was more than twice the cine dose rate. The largest difference between dose rates was for diagnostic catheterization, which had a cine dose rate of 142.6 mGy/min and a fluoroscopic dose rate of 12.6 mGy/min (by a factor of 12.5), followed by EVT, which had a DSA dose rate of 216.0 mGy/min and a fluoroscopic dose rate of 7.7 mGy/min (by a factor of 29.6). The smallest difference between dose rates was for TAVI, which had a cine dose rate of 96.8 mGy/min and a fluoroscopic dose rate of 12.0 mGy/min (by a factor of 8.9), followed by neurologic IVR, which had a DSA dose rate of 227.9 mGy/min and a fluoroscopic dose rate of 9.6 mGy/min (by a factor of 22.6). Compared with the fluoroscopic dose rates, the cine dose rates were 9-13 times higher and the DSA dose rates were 22-30 times higher; the DSA dose rates were more than double the cine dose rates.

Neuroanesthesia Practice During the COVID-19 Pandemic: Recommendations From Society for Neuroscience in Anesthesiology and Critical Care (SNACC).

The pandemic of coronavirus disease 2019 (COVID-19) has several implications relevant to neuroanesthesiologists, including neurological manifestations of the disease, impact of anesthesia provision for specific neurosurgical procedures and electroconvulsive therapy, and health care provider wellness. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert guidance for neuroanesthesiologists during the COVID-19 pandemic. The aim of this document is to provide a focused overview of COVID-19 disease relevant to neuroanesthesia practice. This consensus statement provides information on the neurological manifestations of COVID-19, advice for neuroanesthesia clinical practice during emergent neurosurgery, interventional radiology (excluding endovascular treatment of acute ischemic stroke), transnasal neurosurgery, awake craniotomy and electroconvulsive therapy, as well as information about health care provider wellness. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.