Invasive Treatment Option Research Articles

Post-Traumatic Left Subclavian Artery Pseudoaneurysm Secondary to Clavicular Fracture: A Case Report and Literature Review

Subclavian artery pseudoaneurysms are rare but potentially life-threatening vascular injuries frequently associated with trauma such as clavicle fractures. In this paper we describe the case of a 49-year-old male who developed a post-traumatic pseudoaneurysm of the subclavian artery after a bicycle accident. The diagnosis was delayed due to non-specific symptoms and an initially missed aneurysm on computed tomography imaging. Persistent pain, swelling, and erythema in the subclavian region prompted further detailed diagnostics, which ultimately revealed the pseudoaneurysm. The patient was successfully treated with endovascular stent–graft implantation. We screened the PubMed database to identify similar cases managed exclusively through endovascular intervention. Reports of iatrogenic pseudoaneurysms and those treated with open surgery were excluded. Variables such as time to diagnosis, clinical presentation, features of pseudoaneurysms, and complications were analyzed to highlight the role of endovascular techniques as a minimally invasive and effective treatment option. These cases pose both a diagnostic and a therapeutic challenge, as early recognition of symptoms is crucial to prevent serious complications including thrombosis, neurological deficits, and even limb loss.

Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome: A Double-Blinded Randomized Controlled Trial.

Greater trochanteric pain syndrome (GTPS) is a painful condition that can impair a patient's quality of life. If nonoperative measures fail, progressively more invasive treatment options may be required. This clinical trial aimed to evaluate the effectiveness of ultrasound-guided leukocyte-rich platelet-rich plasma (LR-PRP) injections in the treatment of refractory GTPS caused by bursitis and/or gluteal tendinopathy. An ethically approved, adequately powered, double-blinded randomized controlled trial (RCT) was conducted to evaluate the clinical outcomes in randomized LR-PRP and placebo groups using the International Hip Outcome Tool-12 (iHOT-12), a visual analogue scale (VAS) for pain, the modified Harris hip score (mHHS), the EuroQol 5-Dimensions (EQ-5D) questionnaire, and the presence or absence of complications. All injections were performed under ultrasound guidance into the trochanteric bursa and gluteus medius tendon. The final analysis included 79 patients (39 in the LR-PRP and 40 in the placebo group; 73 female and 6 male; all Caucasian). Both the LR-PRP and the placebo group generally had improvement from baseline that was maintained to 12 months. The only deterioration in scores compared to baseline was seen in the LR-PRP group for the iHOT-12 at 12 months, the EQ-5D index at 3 and 6 months, and the EQ-5D VAS at all follow-up time points. However, there was no significant difference between the 2 groups at any follow-up point (p > 0.05). A multivariable linear regression model, with adjustment for age, sex, body mass index, and preoperative baseline score, did not reveal any significant associations between iHOT-12 and EQ-5D score gains at 12 months and treatment. This randomized trial found no significant difference in outcomes between LR-PRP and placebo for the treatment of greater trochanteric pain up to 6 months following the intervention. As a result, we do not support the routine use of PRP for the treatment of this condition. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Eruptive keratoacanthoma secondary to immune checkpoint inhibitors: a narrative review.

The use of immunotherapy is an emerging treatment option for advanced malignancies. Cutaneous adverse events following cancer immunotherapy are well-documented in the literature. The rarer cutaneous adverse effects are less characterized, including eruptive keratoacanthomas (KA). Despite surgical excision remaining the treatment of choice for KA, several case reports have shown intralesional injections to be an effective, non-invasive treatment modality for this cutaneous adverse event. We reviewed the PubMed database for patients presenting with eruptive KA secondary to immune checkpoint inhibitor use. We also included three previously unpublished cases from our own institution. We identified a total of 19 patients (47.4% male, mean age 78.9years, range 67-92years). Patients were treated with intralesional injections, systemic agents, or alternative therapy (n = 7, 5, 7 respectively). Improvement of eruptive KA was observed in 89.5% of patients. Immunotherapy was continued or restarted in 13 of 19 cases. Intralesional injection of triamcinolone or methotrexate resulted in complete resolution in all patients when response was characterized. We believe intralesional injections may be an effective, less invasive treatment option than surgical excision when treating eruptive keratoacanthomas secondary to immunotherapy.

Safety and Efficacy of CT-Guided Percutaneous Cryoablation of Large Angiomyolipomas: Case Series and Review of Literature

AbstractTo evaluate the safety and clinical outcomes of percutaneous cryoablation of large renal angiomyolipomas (AMLs), three patients with large predominantly fat-containing AMLs measuring over 4 cm were treated with cryoablation. Two patients underwent cryoablation alone and one patient underwent selective arterial embolization followed by cryoablation. All patients were followed up with cross-sectional imaging. All procedures were performed safely and successfully. The first two patients had no side effects or complications. The third patient developed tachycardia following the procedure that required additional cardiac monitoring and resolved without difficulty. The follow-up imaging demonstrated reduction in size of the AMLs in all three patients. CT-guided percutaneous cryoablation is a minimally invasive, viable, and safe treatment option for large AMLs without a significant vascular component while improving the patient's clinical outcomes.

Penile shear-wave elastography predicts the outcome of botulinum neurotoxin (Botox) in the management of non-responders to phosphodiesterase-5-inhibitors: A pilot study

ABSTRACT Objective Botulinum neurotoxin (BoNT) was introduced as a minimally invasive treatment option for erectile dysfunction (ED). However, there is no proven method that predicts improvement after BoNT injection. Shear wave elastography is an emerging imaging modality that evaluates tissue stiffness. This study aims to assess the reliability of SWE in predicting BoNT response in patients with ED and phosphodiesterase 5 inhibitors (PDE-5i) non-responders. Methods This study comprised 20 men presenting with ED and PDE-5i non-responders. Mean tissue stiffness values (TSVs) were measured by SWE, international index of erectile function (IIEF-5), erection hardness score (EHS), sexual encounter profile questions 2 and 3 (SEP-2 and SEP-3), and global assessment questionnaire (GAQ) were evaluated before and after 100 IU of BoNT injection by 6 and 12 weeks. Results In comparison with baseline, there was a significant improvement in IIEF-5 and EHS scores after BoNT injection at 6- and 12 weeks (p < 0.001). Similar improvements were observed in SEP-2&3 (p < 0001 & p = 0.001, respectively) and GAQ-1&2 (p = 0.008 & p = 0.006, respectively). We found that mean SWE in a penile flaccid state can predict failure of clinically significant improvement after BoNT injection using a cutoff point of 12.7 kPa (sensitivity = 100%, specificity = 54%, AUC = 0.86, p = 0.014). Conclusion This finding could be applied to avoid unnecessary BoNT injections in men with ED and PDE-5i non-responders.

Dual peptide-coordinated dynamic hydrogel with antibacterial and proangiogenic activities for infected skin wounds

Infected skin wounds represent a class of significant clinical challenges due to their complexity and the risk of delayed healing. Developing an effective wound dressing capable of promoting tissue regeneration while addressing infections is crucial. In this study, we designed a dual peptide-coordinated dynamic hydrogel with both antibacterial and proangiogenic properties, specifically tailored for treating infected skin wounds. The dynamic hydrogel was constructed using gelatin, a natural biomacromolecule with high biocompatibility, as the base material. Two functional peptides, the antibacterial melittin and angiogenic peptide, were incorporated to enhance both infection control and tissue repair. Hydrogelation was achieved through coordination interactions between gold (Au) ions and sulfhydryl groups, endowing the hydrogel with dynamic properties. The excellent biocompatibility, antibacterial efficacy and angiogenic capability of hydrogel allow it to provide structural support for wound healing while promoting cell proliferation and migration. By eradicating bacteria and stimulating new blood vessel formation, it accelerates the healing of infected wounds. Additionally, its injectability and self-healing properties make it suitable for treating irregularly shaped and deep wounds. This dual-functional hydrogel may offer a promising and minimally invasive treatment option for infected skin wounds, combining high biological safety with simplified surgical procedures.

Contemporary Management of the Aortic Valve-Narrative Review of an Evolving Landscape.

Background: Aortic valve replacement has undergone novel changes in recent decades, providing not only a multitude of procedural options but expanding the treatable patient population. Specifically, a number of minimally invasive and interventional treatment options have allowed for the treatment of high and prohibitive risk surgical patients. Further, technology is allowing for the development of innovative surgical and transcatheter valve models, which will advance the treatment of aortic valve disease in the future. Objective: Here, we choose to describe the modern aortic valve replacement techniques and the available valves and designs.

Annual full mouth debridement reduces the need for dental treatment in personnel working in hazardous conditions

BACKGROUND: Relevant data on the need for dental treatment, including differentiated parameters of treatment needs in various groups of patients enrolled in care, are essential for the justification of compulsory health insurance financing and adequate staffing of the dental service. AIM: To compare the need for dental treatment in personnel of the Kalinin Nuclear Power Plant working in hazardous conditions, depending on the presence or absence of previous full mouth debridement. MATERIALS AND METHODS: A clinical and X-ray examination of the teeth and periodontal tissue was performed in two groups of personnel of the Kalinin Nuclear Power Plant working in hazardous conditions. One year prior to the examination, subjects in the first group voluntarily declined the proposed full mouth debridement, while subjects in the second group received therapeutic and surgical debridement according to the compulsory health insurance plan. RESULTS: The need for treatment of dental caries and its complications decreased by 27.8% following full mouth debridement. In particular, the need for single and double dental filling decreased by 46.0% and 53.5%, respectively; the need for primary and revision root canal therapy decreased by 48.0% and 43.3%, respectively; and the need for tooth extraction decreased by 81.1%. The need for flap surgery and periodontal pocket curettage decreased by 32.8% and 38.8%, respectively, while the requirement for calculus removal and local drug therapy increased by 7.1%. CONCLUSION: Personnel of the Kalinin Nuclear Power Plant working in hazardous conditions showed a high need for treatment of dental caries and periodontal diseases. There was a significant decrease in the need for dental filling, root canal therapy, and tooth extraction in subjects with previous full mouth debridement, with a shift toward less invasive periodontal disease treatment options. Specific data on dental treatment needs in personnel working in hazardous conditions can be used for financial planning and staffing of the dental service.

Real-life nationwide outcomes of bronchoscopic lung volume reduction with endobronchial valves in severe COPD.

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death globally, characterized by airflow limitation and lung hyperinflation due to emphysema. Bronchoscopic lung volume reduction (BLVR) with endobronchial valves offers a minimally invasive treatment option for emphysema, aiming to reduce lung hyperinflation, thereby improving lung function and exercise tolerance. This study evaluated the efficacy of BLVR in a real-life nationwide setting using comprehensive Danish registries. The study population included patients who underwent BLVR between January 1, 2013, and December 31, 2021. We assessed clinical outcomes, including Forced Expiratory Volume in 1 second (FEV1), Medical Research Council (MRC) dyspnea score, and the rates of exacerbations and pneumonia before and after the procedure. A control cohort of matched COPD patients was also analyzed. Following BLVR, a significant increase in FEV1, similar to the improvements reported in randomized controlled trials was observed. Additionally, the proportion of patients classified as GOLD stage IV decreased from 71.3% to 60.6% after BLVR. The incidence rate ratio for severe exacerbations significantly dropped to 0.56 (95% CI 0.47-0.67, p<0.01) after BLVR. No significant changes were observed in the rates of moderate and severe pneumonia, and mortality rates did not differ significantly from those in the matched control cohort. This study demonstrates the real-life efficacy of BLVR using endobronchial valves, highlighting a significant improvement in FEV1 and a reduction in severe COPD exacerbations. The procedure did not increase pneumonia rates or affect mortality, supporting continued use of BLVR for managing patients with COPD.

Restoring with flowables: An injection moulding technique – A report of two cases

This case report showcases the conservative management of aesthetic anterior restorations for patients seeking to enhance their smiles using the highly filled flowable composite resin injectable moulding technique. This efficient method resulted in optimal, aesthetically pleasing outcomes, leading to high patient and dentist satisfaction. Direct veneers made from injectable flowable resin composites provide a minimally invasive treatment option, given that the case selection criteria are appropriately followed. Furthermore, this approach can be viewed as a more cost-effective alternative. However, additional follow-ups are essential to thoroughly assess the clinical longevity of both the restorations and the materials utilised.

Spontaneous hemorrhage in adrenal myelolipoma treated with elective laparoscopic adrenalectomy following selective arterial embolization

IntroductionAdrenal myelolipoma is a benign adrenal tumor that is typically asymptomatic and is rarely associated with hemorrhage or rupture. Here, we present a case of adrenal myelolipoma with spontaneous hemorrhage.Case presentationA 72‐year‐old man with a history of obesity and hypertension visited the Department of Emergency Medicine with a sudden onset of severe left flank pain. Enhanced computed tomography showed a left adrenal tumor containing a fat component with a focus of contrast medium visualized extravasation. The patient was diagnosed with adrenal myelolipoma with spontaneous hemorrhage. Selective adrenal arterial embolization was performed to manage the severe pain, and the condition immediately improved. Four months later, laparoscopic left adrenalectomy was performed via a transperitoneal approach. Histopathological examination confirmed the diagnosis of adrenal myelolipoma.ConclusionUrgent transarterial embolization followed by elective laparoscopic adrenalectomy is a safe and minimally invasive treatment option for managing adrenal myelolipomas with hemorrhage.

Ethanol Sclerotherapy for Endometriomas in Infertile Women: A Narrative Review.

Ethanol sclerotherapy (EST) has gained attention as a minimally invasive treatment option for ovarian endometriomas, particularly in infertile women with endometrioma undergoing in vitro fertilization (IVF). Endometriomas are associated with decreased ovarian reserve and impaired fertility outcomes, and traditional surgical approaches, such as cystectomy, often lead to further reductions in ovarian reserve. Ethanol sclerotherapy offers a potential alternative that preserves ovarian function while effectively managing endometriomas. This review examines the safety, efficacy, and impact of EST on ovarian reserve, IVF outcomes, and recurrence rates. Comparative studies suggest that pregnancy rates following EST are similar to or better than those after cystectomy, with the added benefit of more oocytes retrieved, which may lead to higher cumulative live birth rates. Despite these promising results, challenges such as recurrence and complications, particularly with prolonged ethanol exposure, remain. The use of transvaginal versus laparoscopic approaches and optimal ethanol exposure protocols are areas of ongoing research. The need for further large-scale, prospective studies is highlighted to refine the EST protocol and better understand the long-term outcomes. Sclerotherapy presents a feasible option for preserving fertility in women with endometriomas, with positive implications for IVF success and ovarian reserve preservation.

Bevacizumab for Vestibular Schwannomas in Neurofibromatosis Type 2: A Systematic Review of Tumor Control and Hearing Preservation.

Background/Objectives: Vestibular schwannomas (VSs), also called acoustic neuromas, are benign tumors affecting the vestibulocochlear nerve, often leading to hearing loss and balance issues. This condition is particularly challenging in patients with neurofibromatosis type 2 (NF2), where VSs tend to develop bilaterally. Conventional treatments, such as surgery and radiotherapy, although effective, carry risks like hearing loss and nerve damage. Bevacizumab, a VEGF-targeting monoclonal antibody, has emerged as a less invasive treatment option, showing potential for tumor volume reduction and hearing preservation. This systematic review aims to assess the efficacy of bevacizumab in controlling tumor volume, preserving hearing, and identifying associated adverse events. Methods: A comprehensive systematic review was performed using PRISMA guidelines. PubMed and Cochrane Library databases were searched for studies evaluating the effects of bevacizumab on VS, focusing on key outcomes like tumor volume reduction, hearing preservation, and adverse events. Data extraction and quality assessment were independently conducted by two reviewers using the Newcastle-Ottawa Scale. Results: Nine studies involving 176 patients were included. Bevacizumab showed a partial tumor volume reduction (≥20%) in 40% of cases and disease stabilization in 50%, while 10% experienced tumor progression. Hearing outcomes revealed improvement in 36% of patients, stabilization in 46%, and deterioration in 18%. Severe adverse effects, including hypertension and thromboembolic events, occurred in 13% of patients, while 18% reported no side effects. Tumor regrowth was observed in some patients after treatment discontinuation, emphasizing the need for long-term monitoring. Conclusions: Bevacizumab demonstrates effectiveness in managing VS, particularly in NF2 patients, by reducing tumor size and preserving hearing in a substantial proportion of cases. However, the variability in patient response and the risk of adverse events underscore the need for individualized treatment approaches and further research, including randomized controlled trials, to optimize its clinical application.

Robot-assisted stylomastoid foramen puncture and radiofrequency ablation for hemifacial spasm treatment: clinical outcomes and technique assessment.

Stylomastoid foramen (SMF) puncture with radiofrequency ablation (RFA) is a minimally invasive therapy for hemifacial spasm (HFS) with notable therapeutic outcomes. Conventionally, this procedure is performed under CT guidance. The present study highlights the authors' preliminary clinical experience with robot-assisted SMF puncture in 7 patients with HFS using a neurosurgical robot. Patients were secured in a skull clamp, and their heads were linked to the Sinovation neurosurgical robot's linkage arms for precise positioning. Bone fiducial registration was conducted using the robotic pointer. Under robotic guidance, a puncture needle was positioned at the skin entry point and then advanced to the target with a surgical blade incision. On target attainment, an RFA electrode was positioned, and the ablation was performed while monitoring facial nerve function. Preoperative and postoperative spasm grading, surgical metrics, and adverse events were meticulously documented. The puncture trajectories averaged 49.5 mm in length, and the overall operation duration was 27.3 minutes. Guided by the robotic arm, all puncture attempts were successfully achieved without any obstructions, and SMF puncture was completed in a single attempt. Following RFA, immediate spasm relief was achieved, with all patients attaining Cohen spasm grade 0. Over a mean follow-up period of 12 months (range 6-15 months), no recurrence of spasms was reported. Facial paralysis was observed in 85.7% of patients, with 6 cases classified as House-Brackmann (HB) grade II and 1 case as grade III. At the final follow-up, 1 patient remained at HB grade II, while the remaining patients improved to grade I. No other lasting or severe complications were recorded. SMF puncture and RFA emerge as a potent and minimally invasive treatment option for HFS. The robot-assisted approach, despite necessitating additional time for head fixation and registration, notably reduces the overall puncture time, puncture attempts, and radiation exposure, thereby enhancing the puncture success rate.

Standalone interventional glaucoma: evolution from the combination-cataract paradigm.

One of the most impactful recent developments in the glaucoma community has been the concept of interventional glaucoma. In brief, this paradigm shift involves proactive rather than reactive intervention to address glaucoma earlier in the disease process, including in both standalone and combination-cataract settings. By intervening earlier with minimally invasive surgical, laser, or drug-delivery treatments instead of prolonged topical medications, interventional glaucoma aims to take the burden of medication compliance off the patient. It also allows for standalone surgical interventions rather than letting cataract surgery dictate the glaucoma treatment plan. This interventional mindset has been made possible by the increasing diversity and availability of effective minimally invasive treatment options. With these options as a springboard, it is time to reevaluate and advance the traditional glaucoma treatment paradigm.

Clear Aligner Treatment: Different Outlook between Orthodontists and General Dentists

The increasing adoption of clear aligner therapy (CA) has highlighted contrasting viewpoints between orthodontists and general dentists concerning its application and management. This study investigates these divergent perspectives, focusing on the advanced training and expertise of orthodontists, which enables them to conduct thorough evaluations of intricate dental alignments and aesthetic factors. Conversely, general dentists perceive CAs as a more user-friendly and less invasive treatment option, allowing them to offer these services in a more accessible manner. Such disparities prompt important considerations regarding treatment efficacy, patient outcomes, and the delineation of professional responsibilities within dentistry. To assess these differences, a web-based survey was conducted among 64 dental practitioners, exploring their demographics, experiences with CA, types of patients treated, and specific malocclusions addressed. The data were analyzed using SPSS software version 23. Results revealed that 57% of respondents reported incorporating CA into their practices, with a significantly higher percentage of orthodontists (P = 0.001). Orthodontists primarily treated Class I malocclusions characterized by crowding, spacing, deep bites, and open bites. The majority of CA patients were employed adults, with an equal distribution of males and females seeking treatment; notably, the prevailing source of information about CA was external media advertising. In conclusion, the study identifies significant differences in the utilization of CA between orthodontists and general dentists, particularly regarding practitioner numbers, experience levels, and case selection strategies. As clear aligner therapy continues to develop, understanding these distinctions will be crucial for optimizing patient care. Keywords: clear aligner, Orthodontists, General dentists

Vertebroplasty for painful osteoporotic vertebral compression fractures: a protocol for a single-center doubled-blind randomized sham-controlled clinical trial. VOPE2

BackgroundOne in three women and one in five men over the age of 50 will experience an osteoporotic fracture. Vertebral fractures can be very painful, affect patients’ daily function, and in severe cases require hospitalization. Traditionally, fracture pain is treated conservatively with analgesics, and bracing. Vertebral augmentation, also known as vertebroplasty, has been used during the last three decades as a minimally invasive treatment option for vertebral compression fractures, but the evidence base for its efficacy is weak. We describe a double-blind randomized sham-controlled clinical trial to assess the impact of vertebroplasty on self-reported clinical outcomes in patients with painful osteoporotic vertebral compression fractures and vertebral oedema.MethodsTwo hundred and forty patients with painful osteoporotic vertebral fractures and MRI verified oedema will be randomized in a prospective, double-blind, single-center, clinical trial to either vertebroplasty or a sham procedure, with the possibility of crossover 12 weeks after randomization and operation. The primary outcome will be difference in self-reported pain 12 weeks after treatment between the vertebroplasty and sham group. Secondary outcomes will be patient-reported disability, health-related quality of life, societal costs of treatment and complications. Analysis will be based on intention-to-treat. Repeated measures ANCOVA with baseline ODI, Numerical Pain Rating Scale, EQ-5D-5 L, and number of levels involved as co-variates will be performed.DiscussionWith an aging population, the prevalence of osteoporosis and related complications such as vertebral compression fractures is expected to increase. Therefore, there is a growing need for evidence-based fracture treatments. This study fills a gap in the evidence base for treatment of painful osteoporotic vertebral fractures and will likely influence future treatment guidelines.Trial registrationThe study has been evaluated and approved by the Regional Committees on Health Research for Southern Denmark October 9 2023 (Projekt-ID S-20230058) and the Danish Data Protection Agency 23/40,938. The protocol has been registered at ClinicalTrials.gov with trial registration number NCT06141187 November 21, 2023.

Ethanol Chemical Gallbladder Ablation for Cholecystitis in Inoperable Elderly Patients.

Cholecystitis presents significant treatment challenges, especially in elderly patients with high surgical or anesthetic risks. While cholecystectomy remains the standard intervention, its feasibility is sometimes limited, leading to reliance on cholecystostomy, which has a high recurrence rate and does not address the underlying cause. The aim was to evaluate the efficacy and safety of chemical gallbladder ablation as a minimally invasive treatment option for acute cholecystitis in elderly and comorbid patients. This retrospective study included patients admitted for chemical gallbladder ablation from 2014 to 2024, contraindicated for cholecystectomy/anesthesia. Procedures involved ultrasound-guided drainage, cholangiography, potential cystic duct embolization, and ethanol ablation. Outcomes measured included complications, recurrence rates, gallbladder atrophy rates, and hospital stay duration. Of 24 patients considered, 20 underwent chemical ablation with no reported complications or ethanol intoxication, with one recurrence of cholecystitis. 9 patients underwent cystic duct embolization prior to chemical ablation. The median hospital stay duration and post-procedure overall survival was 20 and 603days, respectively. Among the 13 patients who received follow-up imaging, gallbladder atrophy was achieved in 5 of the 6 patients who had cystic duct embolization prior to chemical ablation, and 2 of the 7 patients who had not cystic duct embolization. This series suggests that chemical gallbladder ablation with cystic duct embolization could be a viable, safe and minimally invasive option for managing acute cholecystitis in elderly, multimorbid patients. Further research is necessary to validate these findings.

Percutaneous Device Closure of Perimembranous Ventricular Septal Defects Associated with Aortic Valve Prolapse and Aortic Regurgitation.

The progression of aortic regurgitation (AR) in perimembranous ventricular septal defects (pVSD) remains uncertain; research indicates that the accompanying AR tends to worsen over time. There is controversy surrounding the percutaneous closure of defects in patients with pVSD associated with aortic valve prolapse (AVP) and AR. Our research focused on transcatheter closure for pVSD accompanied by AVP, AR, and septal aneurysm, with the aim of addressing challenges through device placement in aneurysmal tissue to eliminate the Venturi effect. We studied 44 patients with AVP, AR, and septal aneurysm who underwent transcatheter device closure. The mean age and weight were 10.5 ± 4.0years and 36.0 ± 15.1kg, respectively. Transcatheter closure was attempted in 44 patients. One case (2.3%) was referred to surgery, while the procedure was successfully completed in 43 out of 44 patients (97.7%). Early complications were minimal. Embolization of the device to the pulmonary artery was observed in one patient; upon re-evaluation, significant aneurysm tissue damage was detected, leading to a referral for surgery. Additionally, three patients (6.9%) developed permanent incomplete right bundle branch block (iRBBB). The median follow-up time was 43months. During the follow-up period, AR progressed in only 1(2.3%) patient, while AR in 7(16.3%) patients regressed markedly. Follow-up assessments demonstrated high rates of complete occlusion; the rates at immediate, 24h, 6months, and 1year were assessed as 72, 83.7, 93, and 95.3%, respectively. Transcatheter device closure of pVSD offers a minimally invasive, safe, effective, and alternative treatment option for patients with pVSD associated with AVP and AR.

Diagnosis and Treatment of Choledochal Cysts: A Comprehensive Review with a Focus on Choledochocele.

Choledochal cysts (CCs) are cystic dilations of intrahepatic and/or extrahepatic bile ducts. Around 80% of CCs are diagnosed within the first decade of life. These complex clinical entities are extremely rare, especially in the Western population. CCs are frequently classified according to the Todani classification. CCs may be asymptomatic or present as acute pancreatitis and/or cholangitis, biliary obstruction, or malignancy. Therefore, the diagnosis relies primarily on abdominal imaging modalities, mainly magnetic resonance cholangiopancreatography. Management is tailored based on the cyst morphology and the patient's clinical characteristics, with surveillance, surgery, and interventional endoscopy being the most frequent management options. While the surgical approach is the most frequently employed, type III CCs (also known as choledochocele) are frequently managed endoscopically, and novel endoscopic, minimally invasive treatment options are rapidly emerging.