Percutaneous Procedures Research Articles

Fasting prior to percutaneous cardiovascular procedures: is it time to abandon this time-honoured practice?

Fasting prior to percutaneous cardiovascular procedures: is it time to abandon this time-honoured practice?

Methodological notes on physical parameters of low-level laser irradiation. Part 2. Light dosage at laser therapeutic sessions

Purpose. The general goal of this methodological article, consisting of two parts, is to provide a unifying theoretical approach to the still debated problem on determining the depth of laser light penetration into biotissues and the dosage of laser therapeutic effect from the standpoint of modern medical physics. The purpose of the second part of the article is to demonstrate that calculation of the absorbed dosage at laser therapy sessions is similar to the calculation of classical doses in radiobiology and radiation therapy.Materials and methods. The authors reviewed current state of terms and definitions related to the calculation of doses in ionizing and non-ionizing radiation. The Monte Carlo method was used to simulate the soft tissue volume in which 95 % of radiation energy is absorbed. A classical absorbed dose measured in Grays was estimated. Numerical simulation of absorbed doses for various typical laser therapy procedures was performed.Results. It has been shown that the effective irradiated volume of tissues, despite of small variations in soft tissue density between patients, allows to calculate the absorbed radiation dose in Grays, similar to radiobiological doses. Comparative findings on a single local absorbed dose for various percutaneous therapeutic procedures do not contradict the known clinical data, and even more, make the relationship of different doses for different therapeutic purposes more clear. As it has been found, typical doses range from 0.7 Gy for intravascular blood irradiation to 106 Gy for destructive photodynamic therapy and UV therapy procedures in dermatology.Conclusion. The proposed methodological approach proposes a new look at both the problem of the depth of laser light penetration into biotissues and the problem of laser light doses during therapeutic and diagnostic procedures from a unified medical and physical standpoint.

Risk of bleeding after percutaneous liver procedures in patients with cirrhosis: myth or fact?

Risk of bleeding after percutaneous liver procedures in patients with cirrhosis: myth or fact?

Abstract 4134878: Single Perclose Plus Angioseal Versus Double Perclose for Percutaneous Femoral Access: A Systematic Review and Meta-Analysis

Background: Vascular Closure utilizing Suture Based Devices (SBD) is an established approach for large-bore arterial access in percutaneous procedure patients. Standard of care uses two devices when accessing the artery with 8 Fr sheaths and above. The bailout use of Plug-based devices (PBD) is well established, but little is known about the intentional combination of SBD with PBD and how this technique compares to the standard approach. We aimed to compare these different approaches in this meta-analysis. Methods: PubMed, Scopus, and Cochrane databases were searched for observational studies comparing the hybrid approach to the standard one utilizing exclusively SBDs for arterial closure in large bore vascular access and reported the outcomes of (1) Access-related complications (ARC); (2) Major bleeding; (3) All bleeding events; (4) Need for surgical intervention; (5) Need for endovascular intervention ; (6) Device failure; (7) Pseudoaneurysm. Heterogeneity was examined with I2 statistics. A random-effects model was used for all outcomes. Results: We included five observational studies with 1,586 patients, of whom 1,489 (93.8%) underwent TAVI and 97 (6.1%) EVAR. Sheath size had an average of 20.56 Fr in the EVAR patients. ARC (RR 0.48; 95% CI 0.28-0.81; p<0.01), major bleeding (RR 0.29; 95% CI 0.19-0.44; p<0.01), all bleeding events (RR 0.36; 95% CI 0.23-0.56; p<0.01), surgical intervention (RR 0.28; 95% CI 0.10-0.78; p=0.01), or endovascular intervention (RR 0.53; 95 % CI 0.28-0.98; p=0.04), and device failure (RR 0.28; 95% CI 0.11-0.72; p<0.01) were significantly less common in patients treated with the hybrid technique compared to standard care. Pseudoaneurysm (RR 1.13; 95% CI 0.57-2.25; p=0.71) was not significantly different between groups. Conclusion: These findings suggest the hybrid technique, was associated with fewer access complications compared to the standard double SBD as a closure strategy in patients with large bore arterial access.

Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures.

The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well astake steps to minimize risks. A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J.Biopsy and tumorablation were deferred from this article. 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still canarise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.

Xanthogranulomatous Cholecystitis: A Retrospective Review of Clinical Diagnosis and Treatment from a Single Center.

The objective of this study was to evaluate and compare the histopathological, clinical, and treatment characteristics of xanthogranulomatous cholecystitis (XGC) in patients undergoing cholecystectomy at a single center. Aim: We aim to enhance the understanding of its presentation and improve its differential diagnosis from other gallbladder pathologies. Methods: We retrospectively reviewed 6783 cholecystectomy cases performed between January 2015 and January 2023 at the General Surgery Clinic of Haydarpaşa Numune Training and Research Hospital, and a diagnosis of xanthogranulomatous cholecystitis was histopathologically established in 131 patients. In this retrospective study, we examined the clinicopathological characteristics, preoperative imaging methods and findings, histopathological images, surgical procedure methods, and postoperative complications of 131 patients. Results: The study included 131 patients, with ages ranging from 18 to 88 years, of which 74 (56.5%) were female and 57 (43.5%) were male. Ultrasound imaging was performed on 128 patients. Ultrasound imaging revealed wall thickening in 72.7% of cases, hypoechoic nodules in 13.3%, biliary tract pathologies in 10.9%, and adenomyomatosis in 3.1%. A total of 59 cases had MRI. On MRI, wall thickening was observed in 50.8% of cases, biliary tract pathologies in 33.9%, adenomyomatosis in 10.2%, hypoechoic nodules in 3.4%, and hypoechoic nodules + wall thickening (HN + WT) in 1.7%. Histopathological diagnosis was diffuse in 79.4% of cases and focal in 20.6%. In addition to cholecystectomy, non-surgical interventions were not required in 77.1% of the cases, while 11.5% underwent ERCP, 9.2% underwent percutaneous procedures, 1.5% underwent both ERCP and percutaneous procedures, and 0.8% underwent other non-surgical interventions. Of the surgeries, 93.1% were elective and 6.9% were emergency. Postoperative complications were not observed in 84% of the patients; 5.3% experienced surgical complications, 5.3% had surgical site infection, and 5.3% had other complications (pneumonia and urinary infection). The length of hospital stay ranged from 0 to 26 days, with a mean of 5.27 ± 4.59 days and a median of 4 days. Conclusions: Xanthogranulomatous cholecystitis is a rare disease of the gallbladder with no characteristic radiological or clinical findings and can often be confused with gallbladder cancer. Further studies involving larger populations are needed to improve the preoperative diagnosis.

Ultrasound guided procedures in the musculoskeletal system: a narrative review with illustrative examples.

Ultrasound guidance plays a pivotal role in percutaneous procedures for diagnosing and managing musculoskeletal disorders. Such procedures encompass biopsies for tumor, diagnostic aspiration and therapeutic drainage of abscesses, hematomas, cysts and fluid collections, therapeutic injections into joints, nerves, and tendons, as well as aspirations of calcium deposits and extraction of foreign bodies. This review aims to compile the most frequent ultrasound-guided procedures in the musculoskeletal system and present the state-of-the-art in current advances and evidence. We performed a literature review on interventional ultrasound in the musculoskeletal system, and included reviews, systematic reviews, meta-analysis, and clinical trials published during the last 10 years. Articles related to imaging techniques different from ultrasound, or spinal, thoracoabdominal and facial procedures were excluded. A total of 120 articles were selected and included in this review. We qualitatively synthesized the main findings and complemented the review with illustrative images from our daily practice. Most of the reviewed studies found superiority of ultrasound-guided versus landmark-guided procedures. Ultrasound was generally considered as a valuable tool for many specialists in diagnosing and treating many musculoskeletal pathologies, but some disparities in needle approaches, techniques, medication, and doses make it difficult to draw strong evidence in different clinical scenarios. Advances in ultrasound-guided procedures in the musculoskeletal system have enabled radiologists and other specialists to achieve high accuracy in diagnosing and treating various musculoskeletal conditions, including tumors, inflammatory and degenerative arthritis, tendinopathies, and bursal pathologies.

Preoperative Immersive Virtual Reality (iVR) Applied to Percutaneous Nephrolithotomy: A Prospective Randomized Clinical Study of Surgical Planning and Clinical Outcomes.

Percutaneous nephrolithotomy (PCNL) is the procedure of choice for the management of complex or large renal stones. A major challenge for the surgeon, however, is the need to assimilate the nearly 2000 static images from a CT scan into a functional mental image to enable surgical planning. Accordingly, we investigated the potential of immersive virtual reality (iVR) to enhance surgical planning and its impact on the outcomes among patients undergoing PCNL. Between 2019-2023, 175 patients undergoing PCNL were pre-operatively randomized into a CT-only group (N=89) or a CT+iVR group (N=86). CT scans were rendered into iVR models that allowed the surgeon not only to visualize and manipulate each patient's relevant anatomy, but also simulate the percutaneous approach to the proposed calyx. Post-operative CT scans were defined as absolute stone-free, <2mm remnants or 2.1-4mm remnants. Pre-operative visualization of the iVR model resulted in a changed calyx of entry in 30% of cases. The CT+iVR group had a significant improvement in absolute stone-free rate (33.70% vs. 20.22%, p=0.043) and overall <4mm remnant rate (62.79% vs. 48.20%, p=0.044). Clavien-Dindo II+IIIa complications were less in the iVR group (3.48% vs. 12.30%, p=0.03). The results were independent of the surgeon's years of PCNL experience. Pre-operative iVR model visualization benefited surgeons and patients alike. From a surgical standpoint, viewing the iVR model resulted in a safer, more effective percutaneous stone removal procedure.

Carbon dioxide (CO2) as an alternative contrast agent in percutaneous transluminal angioplasty procedures for chronic limb-threatening ischemia patients with chronic kidney disease

Background: Chronic limb-threatening ischemia (CLTI) is a very morbid illness that significantly reduces quality of life. The severity of this disease may necessitate revascularization or amputation. Arteriography is frequently performed for the planning of revascularization. Patients with compromised kidney function need alternative contrast agents. CO2 may be utilized in lower extremity vascular diagnostics and intervention, especially in patients at risk for contrast-induced nephropathy (CIN). Case Illustration: An 80-year-old female with bilateral leg pain and leg swelling had an ulcer on her toe for 2 weeks. She had a history of intermittent claudication for 1 year, hypertension for 5 years, kidney stones for 2 years, and chronic kidney disease for 1 year. She underwent an ECG, laboratory, USG, DUS, and CT-angiography examination. From her laboratory result, her initial creatinine was 5.02 mg/dL (eGFR 8 mL/m/1.73 m2). After good hydration, it became 1.28 mg/dL (eGFR 39 mL/m/1.73 m2). After a CT-angiography procedure, her creatinine level was increased (3.7 mg/dL; eGFR 10.9 mL/m/1.73 m2). She was diagnosed with CLTI Rutherford V Fontain 3 left lower extremity. She suggested doing an angioplasty procedure with a safer contrast agent. An angioplasty procedure was done at RSSA Malang with CO2 contrast. After the procedure, her leg pain improved, and her creatinine didn’t elevate. Conclusion: CO2 angiography might be used as a safe alternative contrast medium in patients with CLTI, which benefits the preservation of renal function and prevents limb amputations. Keyword: chronic limb-threatening, chronic kidney disease, CO2 angiography, contrast-induced nephropathy, peripheral artery disease

National dispensing of evidence-based treatment for New Zealand patients before and after peripheral arterial or percutaneous coronary procedures; undertreatment in plain sight

Abstract Background/Introduction Cardiovascular management guidelines recommend that those undergoing arterial procedures for atherosclerotic disease should be on a long-term antithrombotic agent, statin and blood pressure (BP) lowering (triple therapy) to prevent or delay future ischaemic events or death. Internationally, treatment gaps have been reported for people having peripheral arterial disease (PAD) procedures. Purpose We aimed to investigate national rates of triple therapy dispensing before and after admission for a percutaneous coronary intervention (PCI) compared to a PAD procedure. Methods All people aged 18-84 years admitted for a publicly-funded PCI or PAD procedure in New Zealand between 1 January 2015 and 30 June 2020 were identified. Data were linked to national community dispensing records for antithrombotic agents, statins and BP lowering and the adjusted relative risk (adjRR) of dispensing individual medication classes and triple therapy investigated 6 months prior-procedure and 0-6 months and 7-12 months post-procedure. Analyses were controlled for age, sex, prioritised ethnicity, socioeconomic deprivation index, diabetes and prior cardiovascular disease. Results During the study period, 26,383 people were admitted for a PCI procedure and 10,938 people for PAD. Compared to PCI, those with PAD were more likely to be women, older (median age 69 vs 66 years), of Māori or Pacific ethnicity, living in more deprived communities, more likely to have diabetes (33% vs 24%) and a prior admission for cardiovascular disease (63% vs 52%). Triple therapy in the 6 months prior to procedure was 48% for PAD compared to 37% for PCI (adjRR 1.04; 1.03-1.05); however, in the 6 months post-discharge, improved for PCI more than PAD (PAD 58% vs PCI 91%, [adjRR 0.82; 0.81-0,83]) with decreased dispensing in both cohorts by 7-12 months post procedure (PAD 55% vs PCI 83%, [adjRR 0.84; 0.83-0,84]). Conclusions Patients undergoing atherosclerotic arterial procedures are at high risk of future fatal and nonfatal cardiovascular events. Less than half the patients who were admitted for a PCI or PAD procedure had been dispensed triple therapy in the 6 months prior to admission. Post procedure, 91% of PCI patients were on triple therapy but this substantial increase did not occur for PAD patients. The risk management gap for those who have peripheral arterial compared to coronary procedures indicates clear clinical and system-related deficiencies and a national quality improvement approach is required to address these issues. Figure 1. Adjusted relative risk of being dispensed preventive medications for patients who had a PAD procedure, compared to patients who had a PCI procedure [after adjusting for age, sex, ethnicity, NZDep, history of CHD (including prior PCI and CABG), stroke/TIA, haemorrhagic stroke, heart failure, PVD, and diabetes]

Incidence and predictors of radial artery occlusion following transradial coronary procedures

Abstract Background Transradial access for percutaneous coronary procedures has grown in popularity because of its advantages over the femoral approach. However, the benefit is overshadowed by an increased rate of radial artery occlusion (RAO). We aim to assess incidence and predictors of RAO after transradial catheterization. The anatomic variations of the radial artery (RA) were also studied. Methods This prospective study enrolled 427 patients who underwent coronary angiography or angioplasty via transradial access. An ultrasound evaluation of forearm arteries was performed. In case of RAO, another ultrasound check-up was performed after 1 month and 3 months of the procedure. Results Our study population includes 288 patients (32.6% female). The mean age was 61.9 ± 11.1 years. RAO occured in 48 patients (11.24%), among whom spontaneous recanalization was observed within 3 months in 15 patients (32.6%). On multivariate analysis, a younger age (OR 0.642 [CI 95%: 0.480 – 0.858], P = 0.031), low periprocedural systolic blood pressure, (OR 0.598 [CI 95%: 0.415 – 0.862], P = 0.007), a small radial diameter (OR 0.371 [CI 95%: 0.323 – 0.618], P = 0.031), insufficient anticoagulation (OR 0.287 [CI 95%: 0.163 – 0.505], P &amp;lt; 0.001), occlusive hemostasis (OR 0.128 [CI 95%: 0.047 – 0.353], P &amp;lt; 0.001), and a long duration of hemostasis emerged as independent predictors of radial occlusion. The overall incidence of radial artery anatomic variations was 14,8% (n=63). Among these patients, 40 (63.5%) had a high radial origin, 18 (28.6%) had extreme radial artery tortuosity, and 5 (7.9%) had a full radioulnar loop. Conclusion The incidence and prevalence of radial artery occlusion is expected to increase. Insufficient heparinization and occlusive hemostasis are the main modifiable predictors. The preventive strategy should focus primarily on these 2 predictive factors.

Endo-hepatology: Why should we do endoscopic ultrasound-guided interventions to the liver that we could do through the skin?

Endoscopic ultrasound (EUS)-guided interventions on the liver such as diffuse biopsy and portal pressure gradient measurement are emerging as potential alternatives to percutaneous procedures. The purpose of this editorial was to address all the indications that could potentially make an EUS-guided approach a possible alternative to the percutaneous procedures with respect to the proce-dures that could join the EUS examination such as upper endoscopy for gastro-esophageal varices, pancreaticobiliary investigation with EUS, and other potential advantages in terms of patient safety. The issue of a holistic gastroenterologist approach was also discussed along with the potential for developing clinical research.

A case report with literature review: long-term follow-up of kidney autotransplantation in fibromuscular dysplasia.

Fibromuscular dysplasia is a rare, idiopathic, systemic, non-inflammatory, and non-atherosclerotic vascular disease that primarily affects young women. It often presents as renal artery stenosis. Fibromuscular dysplasia can induce tissue damage in the post-stenotic kidney. Treatment options include antihypertensive therapy, surgical revascularization, and transluminal angioplasty with stent implantation. However, kidney autotransplantation is an alternative when these treatments are not feasible. This study presents a case report of a 22-year-old woman with fibromuscular dysplasia, highlighting the long-term success of kidney autotransplantation and reviewing the related literature. A multidisciplinary approach was employed in the treatment of this patient presenting with intermittent headaches, hypertension, and acute kidney disease, andwho was diagnosed with fibromuscular dysplasia. She underwent left aorta-renal bypass and right autotransplantation. Following the procedure, her serum creatinine level decreased from 2.74 to 1.1mg/dL, with an eight-year follow-up confirming the favorableoutcome. Renal artery stenosis is a significant contributor to secondary hypertension, with fibromuscular dysplasia being a rarecause. While medical and interventional treatments are usually effective, complex cases may necessitate alternative approaches. Kidney autotransplantation, albeit uncommon, is an effective option for patients who are unresponsive to conventional therapies. This case demonstrates the successful management of fibromuscular dysplasia-associated renovascular hypertension via kidney autotransplantation, resulting in controlled blood pressure and preserved kidney function. In conclusion, kidney autotransplantation represents a valuable therapeutic option for severe renal artery stenosis caused by fibromuscular dysplasia, particularly when percutaneous procedures are impractical.

Impact of a dedicated radial lounge on same-day discharge percutaneous coronary intervention.

The same-day discharge (SDD) program after elective percutaneous coronary intervention (PCI) is a safe strategy that allows for the optimization of hospital resources. However, the lack of adequate infrastructure and a specially targeted care model may limit its implementation. Our center developed an outpatient care model based on an area designed for percutaneous procedures called radial lounge (RL). Evaluate the efficacy and safety of the RL care model: (1)SDD rate,(2) patient experience,(3) major adverse cardiac events (MACEs) (in-hospital, 30-day, and 1-year mortality andintervention),and (4) vascular access complication. Impact of RL SDD rate on total elective SDD-PCI volume. We conducted a retrospective observational cohort study at a cardiovascular hospital, including consecutive patients undergoing elective PCI between 2015 and 2022 who were admitted to the conventional hospitalization area (CHA) or the RL about the stated objectives. Patient experience was assessed using the Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. A total of 5466 elective PCI procedures were included: 2102 in the RL and 3364 in the CHA. The SDD rate was 85.2% in the RL group and 54% in the CHA. After the implementation of RL, a significant increase in the volume of elective SDD-PCI was observed and patient satisfaction improved significantly (p < 0.005) with CHA. Finally, a greater amount of MACEs were not observed in the RL. The PCI program in RL proved to be safe and effective. It showed a higher rate of SDD and a significant improvement in patient experience was observed without affecting safety.

Preoperative Ultrasound-guided Head and Neck Non-palpable Tumor Detection

Objective: Preoperative ultrasound-guided breast cancer detection was developed in the 1980s for non-palpable breast cancers. This technique was applied to neck surgery in 5 specific cases. Methods: Retrospective study to assess the efficacy and safety of this technique. Results: The mean surgical time was 35.2 ± 15.2 min. There were no complications of this percutaneous target location procedure. All surgical procedures allowed easy target retrieval without any complications. All targets were later confirmed to be the site of cancer. Conclusion: This adaptation of a senology technique to the head and neck region allows us to improve neck procedures by enhancing diagnostic precision, safety, and surgical efficiency.

Clinical and subclinical acute brain injury caused by invasive cardiovascular procedures.

Over the past 50 years, the number and invasiveness of percutaneous cardiovascular procedures globally have increased substantially. However, cardiovascular interventions are inherently associated with a risk of acute brain injury, both periprocedurally and postprocedurally, which impairs medical outcomes and increases health-care costs. Current international clinical guidelines generally do not cover the area of acute brain injury related to cardiovascular invasive procedures. In this international Consensus Statement, we compile the available knowledge (including data on prevalence, pathophysiology, risk factors, clinical presentation and management) to formulate consensus recommendations on the prevention, diagnosis and treatment of acute brain injury caused by cardiovascular interventions. We also identify knowledge gaps and possible future directions in clinical research into acute brain injury related to cardiovascular interventions.

Clinical Outcomes of a Minimally Invasive Percutaneous Brostrom Technique without Arthroscopic Assistance.

Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon's arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes. Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded. A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness. The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology.

Respiration-Induced Organ Motion Compensation: A Review.

Motion of organs in the abdominal and thoracic cavity caused by respiration is a major issue that affects a wide range of clinical diagnoses or treatment outcomes, including radiotherapy, high-intensity focused ultrasound ablation, and many generalized percutaneous needle interventions. These motions pose significant challenges in accurately reaching the target even for the experienced clinician. This review was conducted through comprehensive search on IEEE Explore, Google Scholar, and PubMed. Diverse methods have been proposed to compensate for this motion effect to enable effective surgical operations. This review paper aims to examine the current respiratory motion compensation techniques used across the clinical procedures of radiotherapy, high-intensity focused ultrasound, and percutaneous needle procedures. The complexity of respiratory-induced organ motion and diversity of areas for which compensation can be applied allows for a variety of methodsto be implemented. This review aims to serve as inspiration for the future development of new systems to achieve clinical relevance.

Endoscopic Ultrasound-Guided Drainage of Pelvic Fluid Collections with Lumen-Apposing Metal Stents

Introduction: A pelvic abscess is a potential life-threatening condition that should be managed conservatively whenever possible. Currently, computed tomography or ultrasound-guided percutaneous drainage is still the gold standard approach for pelvic fluid collections (PFCs) requiring intervention. More recently, endoscopic ultrasound (EUS) drainage using lumen-apposing metal stents (LAMSs) has been used off-label in PFCs with similar efficacy, a favorable safety profile, better quality of life, and generally a shorter duration of treatment when compared to the gold standard treatment. Methods: An observational retrospective analysis of 6 patients who underwent EUS-guided PFC drainage with LAMS at our institution was conducted. Records were reviewed to identify etiology, size of the collection, number of endoscopic procedures required until complete resolution, stent indwelling time, concomitant surgical or percutaneous associated procedures, successful removal and resolution. Results: The 6 patients included had an average age of 69 years old and 5 (83.3%) were male. The average size of the PFCs was 72.5 mm. All patients (100%) had successful drainage following LAMS placement, though 1 patient had an early recurrence. The mean stent indwelling time in our study was 6.7 days. An additional percutaneous or surgical drainage intervention was not required in any of the participants. Also, no adverse events related to the procedure were reported during the follow-up period. Conclusion: EUS-guided drainage of PFCs with LAMS is a safe and minimally invasive technique, which allows rapid PFC resolution, with no need for percutaneous or surgical drainage interventions.

Acceptance and feasibility of an augmented reality-based navigation system with optical tracking for percutaneous procedures in interventional radiology - a simulation-based phantom study.

Augmented reality (AR) projects additional information into the user's field of view during interventions. The aim was to evaluate the acceptance and clinical feasibility of an AR system and to compare users with different levels of experience. A system was examined that projects a CT-generated 3D model of a phantom into the field of view using a HoloLens 2, whereby the tracked needle is displayed and navigated live. A projected ultrasound image is used for live control of the needle positioning. This should minimize radiation exposure and improve orientation.The acceptance and usability of the AR navigation system was evaluated by 10 physicians and medical students with different levels of experience by performing punctures with the system in a phantom. The required time was then compared and a questionnaire was completed to assess clinical acceptance and feasibility. For statistical analysis, frequencies for qualitative characteristics, location and dispersion measures for quantitative characteristics and Spearman rank correlations for correlations were calculated.9 out of 10 subjects hit all 5 target regions in the first attempt, taking an average of 29:39 minutes for all punctures. There was a significant correlation between previous experience in interventional radiology, years in the profession, and the time required. Overall, the time varied from an average of 43:00 min. for medical students to 15:00 min. for chief physicians. All test subjects showed high acceptance of the system and rated especially the potential clinical feasibility, the simplification of the puncture, and the image quality positively. However, the majority require further training for sufficient safety in use.The system offers distinct advantages for navigation and orientation, facilitates percutaneous interventions during training and enables professionally experienced physicians to achieve short intervention times. In addition, the system improves ergonomics during the procedure by making important information always directly available in the field of view and has the potential to reduce the radiation exposure of staff in particular by combining AR and sonography and thus shortening CT-fluoroscopy times. · AR navigation offers advantages for orientation during percutaneous radiological interventions.. · The subjects would like to use the AR system in everyday clinical practice on patients.. · AR improves ergonomics by making important information directly available in the field of view.. · The combination of AR and sonography can significantly reduce radiation exposure for staff.. · Rohmer K, Becker M, Georgiades M et al. Acceptance and feasibility of an augmented reality-based navigation system with optical tracking for percutaneous procedures in interventional radiology - a simulation-based phantom study. Fortschr Röntgenstr 2024; DOI 10.1055/a-2416-1080.