Track Embolization Research Articles

Reduced Incidence of Pneumothorax and Chest Tube Placement following Transthoracic CT-Guided Lung Biopsy with Gelatin Sponge Torpedo Track Embolization: A Propensity Score-Matched Study.

Objectives: To evaluate the effectiveness of track embolization using gelatin sponge torpedo in reducing the incidence of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy. Methods: A retrospective single-center analysis of percutaneous computed tomography (CT)-guided transthoracic lung biopsies was performed between 2017 and 2022. After excluding the patients who received an ultrasound-guided biopsy, combined lung biopsy with ablation, fiducial placement, unsuccessful procedure due to uncooperative patient, and age under 18 years, 884 patients' clinical information was collected (667 without track embolization and 217 with track embolization). The incidence of early and late pneumothorax and chest tube placement were compared between the two groups. Propensity score matching (PSM) was applied to minimize selection bias. Univariable and multivariable analyses were performed to determine risk factors for pneumothorax. Results: After PSM, the baseline differences and all factors that could affect the incidence of pneumothorax were balanced between the track embolization group (217 patients) and the non-track embolization group (217 patients). The incidence rates of early pneumothorax (13.4% vs. 24.0% p = 0.005), late pneumothorax (11.0% vs. 18.0% p = 0.021), and chest tube placement (0.9% vs. 4.6% p = 0.036) were significantly decreased in the track embolization group. However, the success rate of tissue diagnosis yield and length of hospital stay were not significantly different between the two groups. In multivariate analysis, the risk of pneumothorax increased as the fissure was passed (OR = 3.719, p = 0.027). Conclusions: Using track embolization with a gelatin sponge torpedo significantly decreased the incidence of pneumothorax and chest tube placement following percutaneous CT-guided lung biopsy.

Decreased Bleeding-Related Adverse Events Using Track Embolization with Gelatin Sponge Slurry after Percutaneous Liver Biopsy: A Propensity Score–Matched Study

PurposeTo evaluate the effectiveness of track embolization using gelatin sponge slurry in percutaneous ultrasound (US)-guided liver biopsy. Materials and MethodsAmong the 543 patients who underwent percutaneous US-guided liver biopsies between September 2018 and August 2021, 338 who did not undergo track embolization and 105 who underwent track embolization were included in the analysis. All procedures were performed with 18-gauge coaxial core biopsy needles. Patients’ laboratory data were reviewed. Patients in both groups were subdivided into the following 2 groups: (a) those with targeted biopsy for a focal liver lesion and (b) those with nontargeted biopsy for a liver parenchyma. Moreover, postbiopsy events, such as transfusion and transarterial embolization, were assessed. To minimize selection bias, propensity score matching (PSM) was performed. ResultsAfter PSM, all factors that could affect bleeding risk were well-matched and well-balanced between the 2 groups (P > .474). In the non-track embolization group, 17 (16.2%) patients experienced major or minor bleeding-related adverse events (AEs). In contrast, in the track embolization group, only 5 (4.8%) patients experienced major or minor bleeding-related AEs, which was significantly lower than that in the non-track embolization group (P = .007). All 5 (4.8%) cases of major bleeding-related AEs were observed in the non-track embolization group (P = .024). ConclusionsIn this study, a retrospective analysis was performed using PSM for percutaneous US-guided liver biopsy. Track embolization using gelatin sponge slurry is significantly superior in the prevention of bleeding-related AEs after US-guided liver biopsy.

Abstract No. 530 The role of chest radiographs post computed tomography–guided lung biopsy with gelatinous foam slurry: is it necessary?

To explore whether it is necessary to obtain chest radiographs post CT-guided lung biopsy with gelatinous foam slurry needle track embolization This is an IRB-approved prospective study of 47 patients with lung masses visualized on CT who came to our institution for lung biopsy. At our institution, gelatinous foam with 0.9% sodium chloride is mixed together to create a slurry and administered through a coaxial needle post biopsy. Post biopsy CT is obtained as well as chest radiographs are obtained at 1 and 2 hours post procedure. If a pneumothorax is visualized, the patient is examined clinically and a determination is made whether further intervention with a chest tube is necessary. Of the 47 patients in our study, only one patient had a pneumothorax not visualized on CT (2.1%). 11 patients in our study developed pneumothorax, 10 of which were visualized on CT prior to the patient leaving the CT table and subsequently viewed on the 1 hour and 2 hour post procedure chest radiograph with no significant interval change in size of pneumothorax. One of the known risks of a lung biopsy is pneumothorax. Our study demonstrates a low rate of delayed/developing pneumothorax; one patient of 47 (2.1%). Upon reviewing the images of the one delayed pneumothorax, the lung mass was in the right perihilar region and the final CT image did not extend to the apex and inferior parts of the lung. It is possible that the pneumothorax was there immediately however it may not have been imaged. The trend shown in our study demonstrates that although there is always concern for delayed/developing pneumothorax after lung biopsy with gelatinous foam slurry, the risk is very low. As we continue to add patients to the study, we hope to achieve a large enough sample size to further demonstrate that it may not be necessary to obtain chest radiographs post lung biopsy if the final CT shows no pneumothorax.

Utilization of the track embolization technique to improve the safety of percutaneous lung biopsy and/or fiducial marker placement

PurposeThe purpose of the study was to describe and present outcomes of the track embolization technique with absorbable hemostat gelatin powder during percutaneous computed tomography (CT)-guided lung biopsy and/or fiducial marker placement versus the standard of care (no track embolization) in an attempt to decrease rates of pneumothorax (PTX), chest tube placement, hemorrhage and/or complications, and average cost per patient. Materials and methodsAn institutional review board-approved, case–control, retrospective study was performed in which 125 consecutive patients who underwent track embolization were compared with 124 consecutive controls at one institution. For subjects in whom the track embolization technique was utilized, it was performed passively through a coaxial needle as it was removed. All procedures were performed by one of three attending interventional radiologists. For each group, medical records and procedure images were reviewed for PTX occurring postprocedure, PTX requiring chest tube placement, and occurrence of minor or major complication and/or hemorrhage. Comparison was made with published complication rates, and a cost-per-patient analysis was performed. Statistical analysis was performed utilizing Fisher's Exact Test. ResultsIn track embolization cases versus controls, there were statistically significant reduction in PTX (8.8% vs. 21%; P=.007) and reduction in PTX requiring chest tube placement (4% vs. 8.1%; P=.195). This compares favorably to previously published rates of PTX and chest tube placement of 8%–64% and 1.6%–17%, respectively. None of the pneumothoraces occurring at time of needle placement increased in size with use of the track embolization technique. There were no major complications (including neurological sequela) in the track embolization group. In track embolization cases versus controls, there was a statistically significant reduction in both the rate of major hemorrhage (0% vs. 4%; P=.029) and average cost per patient ($262.40 vs. $352.07; P=.044). ConclusionsCT-guided percutaneous lung biopsy and/or fiducial marker placement were safer utilizing the track embolization technique during trocar removal. In addition, this technique was cost effective in the study population.

Percutaneous Management of Portal Vein Patency and Integrity Problems - Catheter Directed Local Thrombolysis, Stenting, Endoluminal RFA & Angioplasty by Balloon or Stenting

Purpose: Spectrum of PV patency and integrity percutaneous restoration techniques is presented. Material and methods: Total twenty patients with portal hypertension due to PV patency & integrity problem; among them percutaneous recanalization was attempted in fifteen patients with PV tumor thrombus using a novel endoluminal bipolar radiofrequency device. The procedure was completed in twelve of fifteen RFA cases; RFA was followed by balloon angioplasty (six cases) or vascular stent placement (six cases). In two cases catheter directed local thrombolysis was performed to acutely manifest fresh PV thrombosis, caused by thrombophylia and HCC. In two cases of pancreatitis induced PV thrombosis & stricture and one case of pancreatitis induced PV thrombosis & stricture and porto-biliary fistula, PV stenting was performed. The PV tributary was percutaneously accessed under US guidance and 5G guide catheter was manipulated through the obstruction using guidewire technique under DSA guidance. In case of thrombolysis thrombolytic agent was injected directly distal to the thrombus, the stenting procedure was completed by self-expanding vascular stent placement. Results: The technical success rate was 85.0%; in three cases (15.0%) wire conduction through the organized thrombus was impossible. Posprocedure portography documented significantly improved portal vein blood flow in all patients, to whom the procedure was completed. Porto-biliary fistula was successfully managed by percutaneous stenting. In three cases postprocedure bleeding was documented, which led to multiorgan failure and death in one case. Conclusions: The management of PV patency and integrity problems by percutaneous stenting or endoluminal RFA and stenting is an effective technique; it should be suggested as a treatment option for otherwise incurable patients and might be used as a bridge for further treatment. Post-procedure intraperitoneal bleeding is a possible life-threatening complication which should be prevented by procedure track ablation or embolization.

4:06 PM; Abstract No. 207 - Surgifoam for needle track embolization after percutaneous lung biopsy and/or fiducial marker placement reduces the rate of pneumothorax and chest tube placement

Purpose: To expand on preliminary studies on the safety and efficacy of microwave ablation (MWA) of lung malignancies using a larger data set and longer term follow-up than previously published. Materials and Methods: 108 patients (42 female, 66 male, mean age 73 years) received outpatient CT guided percutaneous microwave ablation for a single lung malignancy. Patient data, including procedural reports, hospital and outpatient oncology clinical records, as well as follow-up contrast enhanced CT and PET scans, were retrospectively reviewed. Kaplan-Meier modelling and logistic regression were used. Results: The odds of success are 11.1 times higher for o3 cm tumor vs 43 cm, 95% CI[2.97,41.1], p1⁄4.0003. Tumor type had no effect on technical success. The odds of complication of any kind were 2 times higher for 43cm tumors vs o3cm, though this trended toward significance, p1⁄4.09. For every mm increase in original tumor maximal diameter (OMD), the odds of not attaining success increased by 7%, 95% CI[3%,10%], p1⁄4.0002. Likewise, for every mm increase in OMD, the odds of one or more complications increased by 3%, 95% CI [.1%,5%], p1⁄4.04. The median time for tumor reoccurrence was 62 months, 95% CI [29,na]. Reccurrence was estimated at 22% 36% and 44% for 1, 2 and 3 years, respectively. The median time of cancer-related death was 42 mo, 95% CI[38,na]. In addition, reccurrence was estimated at 31% at 13 mo for tumors 43cm and 17% for those o3cm. Medians could not be estimated due to low event rate for tumors o3cm, only the first quartile was estimated: 24 mo for tumors o3cm and 10 mo for 43cm; this difference trended toward significance, p1⁄4.0513. 54% of patients had one or more complications of various severities including: pneumothorax 32%, bronchopleural fistula 2%, hospital admission 28%, pain 20%, infection 7%, postablation syndrome 4%, and ARDS 4%. No relationship was found for pneumothorax with size or cancer type. Conclusion: This study further supports the safe and effective use of outpatient MWA for the treatment of lung malignancies. Details regarding tumor characteristics and procedural methods will help define appropriate patient selection and treatment technique. 4:06 PM Abstract No. 207

Percutaneous Embolization of Transhepatic Tracks for Biliary Intervention

Significant pain can occur after removing transhepatic catheters from biliary access tracks, after percutaneous biliary drainage (PBD) or stenting. We undertook a randomized prospective study to ascertain whether track embolization decreases the amount of pain or analgesic requirement after PBD. Fifty consecutive patients (M:F, 22:28; age range: 29-85 years; mean age: 66.3 years) undergoing PBD were randomized to receive track embolization or no track embolization after removal of biliary drainage catheters. A combination of Lipoidol and n-butyl cyanoacrylate were used to embolize transhepatic tracks using an 8F dilator. The patients who did not have track embolization performed had biliary drainage catheters removed over a guide wire. A visual analog scoring (VAS) system was used to grade pain associated with catheter removal, 24 h afterward. A required analgesic score (RAS) was devised to tabulate the analgesia required. No analgesia had a score of 0, oral or rectal nonopiate analgesics had a score of 1, oral opiates had a score of 2, and parenteral opiates had a score of 3. The average VAS and RAS for both groups were calculated and compared. Seven patients were excluded for various reasons, leaving 43 patients in the study group. Twenty-one patients comprised the embolization group and 22 patients comprised the nonembolization group. The mean biliary catheter dwell time was not significantly different (p > 0.05) between the embolization group and nonembolization (mean: 5.4 days vs 6.9 days, respectively). In the nonembolization group, the mean VAS was 3.4. Eight patients required parenteral opiates, three patients required oral opiates, and five patients required oral or rectal analgesics, yielding a mean RAS of 1.6. In the embolization group, the mean VAS was 0.9. No patient required parenteral opiates, six patients required oral opiates, and two patients had oral analgesia. The average RAS was 0.6. Both the VAS and the RAS were significantly lower in the embolization group compared with the nonembolization group (p < 0.0023 and p < 0.002, respectively). No complications were seen related to track embolization. Percutaneous track embolization after removal of biliary drainage catheters decreases patient's perception of pain and decreases the amount of required analgesia. In particular, the amount of opiate analgesia required is considerably less.

Liver biopsy methods for pediatric oncology patients.

Liver biopsy is a high-risk procedure in oncology patients, and optimal methods for children have not been established. To assess the effectiveness and safety of two methods of performing liver biopsy in pediatric oncology patients. Between May 1997 and July 1999, 51 liver biopsies (22 percutaneous and 29 transjugular) were performed. The 22 percutaneous biopsies (13 focal hepatic lesions and 9 general liver biopsies) were performed under sonographic guidance; 21 used a spring-loaded needle (usually 18 G). In 21 patients, a coaxial sheath was used to inject a slurry of microfibrillar collagen into the needle track. The 29 transjugular general liver biopsies were performed with a 19-G spring-loaded needle, under sonographic and fluoroscopic guidance. The transjugular technique was used for children with thrombocytopenia, coagulopathy, ascites, or recent bone-marrow transplantation. All biopsies yielded sufficient tissue for diagnostic studies. Bleeding occurred after 3 of 21 percutaneous biopsies, despite coaxial track embolization. No bleeding or other major complication occurred after transjugular biopsy. Coaxial percutaneous biopsy with track embolization was effective, but was not complication-free; it should be reserved for focal lesions or for patients at low risk of bleeding. Transjugular liver biopsy is safe and effective for use in high-risk pediatric oncology patients.

Transhepatic insertion of vascular dialysis catheters in children: a safe, life-prolonging procedure

Central venous catheters (CVC) have been inserted percutaneously since 1989. This technique has been adapted for transhepatic insertion of large-bore catheters in children with occluded central veins. Three children aged 5, 11, and 12 years required hemodialysis or plasmaphoresis for treatment of life-threatening conditions. All central veins were occluded, thus transhepatic insertion of a large-bore catheter was necessary. All children underwent successful placement using a combination of ultrasound guidance and fluoroscopy. No complications occurred. Transhepatic insertion of large-bore catheters can be performed safely in children. Catheter removal should be accompanied by track embolization to prevent exsanguinating hemorrhage. Transhepatic insertion of dialysis catheters is a safe alternative in children with occluded central veins.

Percutaneous liver biopsy and track embolization with steel coils.

Eight patients with liver disease and seriously abnormal blood coagulation underwent biopsy of the liver performed through a percutaneously introduced sheath, followed by embolization of the biopsy track with steel coils. In all cases the biopsy procedure produced profuse bleeding through the sheath. However, the bleeding ceased within a few minutes after coil insertion.