Minimally Invasive Image-Guided Percutaneous Irreversible Electroporation of Adrenal Metastases.

Purpose: A single-center retrospective study was performed to evaluate the safety and efficacy of minimally invasive irreversible electroporation (IRE) to treat metastatic adrenal tumors.

Materials And Methods: This single-center study, approved by the Institutional Review Board, retrospectively analyzed six patients who underwent image-guided percutaneous IRE for adrenal metastases. Pre-procedural imaging included CT, MRI and/or F-FDG PET-CT scans.

Irreversible Electroporation in Treating Colorectal Liver Metastases in Proximity to Critical Structures.

Purpose: To evaluate the safety, effectiveness, and oncological outcomes of irreversible electroporation (IRE) of unresectable colorectal liver metastases (CRLMs) close to critical structures.

Materials And Methods: This is a single-center, institutional review board (IRB)-approved, retrospective analysis of patients who underwent percutaneous computed tomography (CT)-guided IRE of CRLM. Between August 2018 and October 2023, 26 patients had 46 tumors treated with percutaneous IRE in 30 ablation sessions.

Safety and Effectiveness of Irreversible Electroporation in Lymph Node Metastases.

Purpose: Demonstrating the safety and efficacy of percutaneous irreversible electroporation (IRE) for the treatment of lymph node metastases.

Materials And Methods: An IRB-approved, single-center retrospective review was performed on patients with lymph node metastases gastrointestinal, and genitourinary primary cancers. Primary objective safety was evaluated by assessing complications graded according to the Clavien-Dindo Classification, and efficacy was determined by tumor response on follow-up imaging and local progression-free survival (LPFS).

Modified Bethesda criteria for thyroid aspirates significantly decrease nondiagnostic rates without decreasing sensitivity.

Introduction: Previous studies suggest that the adequacy rate of thyroid aspirates can be improved by altering the adequacy criteria of the Bethesda System. We sought to measure the performance of these altered criteria in a prospective fashion.

Materials And Methods: Over a 6-year period, cases with 1 to 59 follicular cells were prospectively classified as "nondiagnostic, favor benign" or "scant but adequate".

Clinical, Functional, and Quality-of-Life Outcomes after Computer Assisted Vacuum Thrombectomy for Pulmonary Embolism: Interim Analysis of the STRIKE-PE Study.

Purpose: To report the first interim analysis of the STRIKE-PE study, evaluating the safety and effectiveness of computer assisted vaccum thrombectomy (CAVT) for the treatment of acute pulmonary embolism (PE).

Materials And Methods: This prospective, international, multicenter study will enroll 600 adult patients with acute PE of ≤14 days and a right ventricle (RV)-to-left ventricle (LV) ratio of ≥0.9 who receive first-line endovascular treatment with CAVT using the Indigo Aspiration System (Penumbra, Alameda, California).

Outcomes of Intravascular Lithotripsy in the Treatment of Chronic Limb-Threatening Ischemia: A Single-Center Retrospective Study.

Purpose: Vascular calcification is an important risk factor for endovascular treatment failure and complications in patients with chronic limb-threatening ischemia (CLTI). Intravascular lithotripsy (IVL) is a pulsatile balloon-based device that has emerged as a tool in the treatment of calcified vessels. The purpose of this study is to evaluate the efficacy and safety of IVL in the treatment of peripheral calcified lesions in CLTI patients.

Intracranial and Extracranial Evaluation.

The vascular lab is an essential tool in diagnosing intracranial and extracranial disease including vasospasm from subarachnoid hemorrhage and carotid artery stenosis in the setting of stroke or transient ischemic attack. This article discusses the indications, protocol, and diagnostic criteria for transcranial doppler (TCD) and carotid artery duplex ultrasound. Intracranial and extracranial arterial testing by way of TCD and carotid imaging carries enormous implications and can provide life or death information.

The Vascular Lab and the Interventional Radiologist.

A vascular laboratory (VL) can be defined as a place where physicians and technologists have a commitment to perform and interpret non-invasive testing with objective techniques that are most appropriate to the facility and the skills of the laboratory personnel. It provides the entry point for many patients as well as being the sight for diagnosis and follow up for patients with vascular disease for Interventional Radiologists (IRs). VLs may be run by a multi-specialty service, may be hospital-based, or may be private practice-based providing more of a concierge service.

Technical Approach to Percutaneous Femoropopliteal Bypass and Deep Vein Arterialization.

In the management of patients with critical limb ischemia endovascular revascularization plays a crucial role improving amputation-free survival, ischemic rest pain, and wound healing. Endovascular standard of care of peripheral arterial occlusive disease involves angioplasty and/or stent placement. The following discussion is intended to familiarize interventional physicians with the rationale, physiological concepts, and technical approach to developing endovascular procedures-percutaneous femoropopliteal bypass and percutaneous deep vein arterialization.

Endovascular Treatment of Infrainguinal Peripheral Arterial Disease (PAD): Update on Stent Technology.

Peripheral artery disease (PAD) is a progressive vascular disease affecting millions of individuals and is a considerable cause of morbidity and mortality worldwide. While balloon angioplasty remains the cornerstone option for endovascular management of arterial stenosis, advances in percutaneous endovascular stent technology have broadened the toolbox of therapeutic options for PAD and have significantly improved function and quality of life. Indeed, covered stents, bioabsorbable stents and drug eluting stents are several of the innovations in stent technology made since the advent of nitinol bare metal stents in the 1980s.

Stent Graft Outcomes in Dialysis Circuits: A Review of Clinical Trials and Literature.

End-stage renal disease is a prevalent medical condition causing significant problems as the majority of patients are being treated with dialysis. While dialysis provides a means to compensate for the renal impairment, arteriovenous grafts and fistulas are often complicated by neointimal hyperplasia, loss of primary patency, and graft failure. Over the last decade, stent grafts have emerged as an alternative to balloon angioplasty and bare metal stents for revascularization in the event of arteriovenous graft occlusion or stenosis.

Radioembolization of Secondary Hepatic Malignancies.

Cancer has become the leading cause of mortality in America, and the majority of patients eventually develop hepatic metastasis. As liver metastases are frequently unresectable, the value of liver-directed therapies, such as transarterial radioembolization (TARE), has become increasingly recognized as an integral component of patient management. Outcomes after radioembolization of hepatic malignancies vary not only by location of primary malignancy but also by tumor histopathology.

Improving IR Ergonomics Using a Flexible C-Arm System.

Purpose: To evaluate the impact of a versatile flexible ceiling-mounted C-arm on active table and gantry repositioning during interventions and its effect on operator discomfort, system usability, and patient safety compared with a traditional ceiling-mounted system.

Materials And Methods: There were 100 IR procedures studied: 50 in a traditional IR system (standard group) and 50 with a novel multiaxis ceiling-mounted system (test group). FlexArm was capable of multiple gantry rotation points allowing increased access to the patient in addition to 236 cm of lateral x-ray detector travel.

Indigo Aspiration System for Treatment of Pulmonary Embolism: Results of the EXTRACT-PE Trial.

Objectives: This study sought to prospectively evaluate the safety and efficacy of the Indigo aspiration system in submassive acute pulmonary embolism (PE).

Background: PE treatment with thrombolytics has bleeding risks. Aspiration thrombectomy can remove thrombus without thrombolytics, but data are lacking.

Radiation therapy alone versus radiation therapy plus radiofrequency ablation/vertebral augmentation for spine metastasis: study protocol for a randomized controlled trial.

Background: Spine metastasis is a common occurrence in cancer patients and results in pain, neurologic deficits, decline in performance status, disability, inferior quality of life (QOL), and reduction in ability to receive cancer-directed therapies. Conventional external beam radiation therapy (EBRT) is associated with modest rates of pain relief, high rates of disease recurrence, low response rates for those with radioresistant histologies, and limited improvement in neurologic deficits. The addition of radiofrequency ablation/percutaneous vertebral augmentation (RFA/PVA) to index sites together with EBRT may improve pain response rates and corresponding quality of life.

"How We Do It" - A Practical Approach to Percutaneous Adrenal Ablation Techniques.

Incidental adrenal masses are common and are found in 4% of the CT scans. While clinical history, laboratory results, and imaging characteristics are typically sufficient for diagnosis of an adrenal lesion, a biopsy is sometimes warranted. In some cases, adrenal mass ablation is subsequently indicated.

Management of High Hepatopulmonary Shunts in the Setting of Y90 Radioembolization.

Treatment paradigms for primary and metastatic malignancies involving the liver have evolved in recent years to include targeted liver therapies. Transarterial radioembolization is at the forefront of therapy in many treatment algorithms. However, due to significant hepatopulmonary shunting, some patients are excluded from this proven treatment due to the possibility of radiation-induced lung injury.

Step-by-Step Approach to Management of Type II Endoleaks.

Seventy-five percent of abdominal aortic aneurysms are now treated by endovascular aneurysm repair (EVAR) rather than open repair, given the decreased periprocedural mortality, complications, and length of hospital stay for EVAR compared to the surgical counterpart. An endoleak is a potential complication after EVAR, characterized by continued perfusion of the aneurysm sac after stent graft placement. Type II endoleak is the most common endoleak, and often has a benign course with spontaneous resolution, occurring in the first 6 months after repair.

Fenestrated Endovascular Abdominal Aortic Aneurysm Repair.

In order to offer more patients a durable endovascular abdominal aortic aneurysm repair parallel, branched, and fenestrated grafts have been utilized. These treatments aim at increasing the quality of the proximal aortic graft landing zone by incorporating the healthy aortic neck at the renal and visceral arteries. Fenestrated endovascular aneurysm repair has provided a standardized and approved treatment option for patients who may otherwise not be candidates for endovascular repair.

Endovascular management of iliac aneurysmal disease with hypogastric artery preservation.

Common iliac artery aneurysms (CIAAs) pose a challenge in endovascular aneurysm repair. Aneurysm repair of CIAA traditionally requires embolization of the ipsilateral hypogastric artery (HA). Symptoms of buttock claudication and more feared complications of pelvic ischemia make HA preservation an appealing addition to aneurysm repair.

Type II endoleaks: diagnosis and treatment algorithm.

Elective abdominal aortic aneurysm (AAA) repair is recommended for aneurysms greater than 5.5 cm, symptomatic, or rapidly expanding more than 0.5 cm in 6 months.