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.

A Surgeon's Guide for Various Lung Nodule Localization Techniques and the Newest Technologies.

Preoperative image-guided localization of lung nodules is necessary for successful intraoperative localization and resection. However, current localization techniques carry significant intraoperative disadvantages for surgeons. Articles were selected through multiple search engines using key search terms and reviewed to compare results, outcomes, advantages, limitations, and complications of various localization methods.

SAVI SCOUT as a Novel Localization and Surgical Navigation System for More Accurate Localization and Resection of Pulmonary Nodules.

. Current techniques for localization and resection of lung nodules carry many intraoperative challenges for surgeons. This article proposes a new localization method for diagnosis and treatment of pulmonary nodules, which provides a navigational system for more accurate lung resection.

Genomic Adequacy from Solid Tumor Core Needle Biopsies of ex Vivo Tissue and in Vivo Lung Masses: Prospective Study.

Purpose To identify the variables and factors that affect the quantity and quality of nucleic acid yields from imaging-guided core needle biopsy. Materials and Methods This study was approved by the institutional review board and compliant with HIPAA. The authors prospectively obtained 232 biopsy specimens from 74 patients (177 ex vivo biopsy samples from surgically resected masses were obtained from 49 patients and 55 in vivo lung biopsy samples from computed tomographic [CT]-guided lung biopsies were obtained from 25 patients) and quantitatively measured DNA and RNA yields with respect to needle gauge, number of needle passes, and percentage of the needle core.

Usefulness of intra-procedural cone-beam computed tomography in modified balloon-occluded retrograde transvenous obliteration of gastric varices.

Aim: To evaluate whether intra-procedural cone-beam computed tomography (CBCT) performed during modified balloon-occluded retrograde transvenous obliteration (mBRTO) can accurately determine technical success of complete variceal obliteration.

Methods: From June 2012 to December 2014, 15 patients who received CBCT during mBRTO for treatment of portal hypertensive gastric variceal bleeding were retrospectively evaluated. Three-dimensional (3D) CBCT images were performed and evaluated prior to the end of the procedure, and these were further analyzed and compared to the pre-procedure contrast-enhanced computed tomography to determine the technical success of mBRTO including: Complete occlusion/obliteration of: (1) gastrorenal shunt (GRS); (2) gastric varices; and (3) afferent feeding veins.

Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results.

Objectives: To describe the technical feasibility, safety, and clinical outcomes of coil-assisted retrograde transvenous obliteration (CARTO) in treating portal hypertensive non-esophageal variceal hemorrhage.

Methods: From October 2012 to December 2013, 20 patients who received CARTO for the treatment of portal hypertensive non-esophageal variceal bleeding were retrospectively evaluated. All 20 patients had at least 6-month follow-up.

The road less traveled: importance of the lesser branches of the celiac axis in liver embolotherapy.

Effective treatment of unresectable hepatic neoplasms depends on the appropriate identification of tumor arterial supply. Because hepatic tumors derive more than 90% of their blood supply from the hepatic arteries, awareness of common hepatic arterial anatomic variants (e.g.

Particle embolization to control life-threatening hemorrhage from a fungating locally advanced breast carcinoma: a case report.

Introduction: Sudden severe hemorrhage from locally advanced fungating breast carcinoma and its associated cutaneous lesions is rarely reported. Transcatheter arterial embolization has been used widely in the setting of intractable neoplastic hemorrhage arising from primary and metastatic tumors of the lung, liver, kidney, and gastrointestinal tract. Here, we detail the use of transcatheter arterial embolization in controlling torrential hemorrhage in a patient with advanced invasive breast cancer and multiple comorbidities.

Irreversible electroporation in eradication of rabbit VX2 liver tumor.

Purpose: To show the effectiveness and safety of irreversible electroporation (IRE) in treating large tumor models.

Materials And Methods: VX2 liver tumor implantation was performed in 35 New Zealand White Rabbits. The rabbits were divided into three groups 1 week after implantation.

Electron microscopic demonstration and evaluation of irreversible electroporation-induced nanopores on hepatocyte membranes.

Purpose: To demonstrate, evaluate, and verify the existence of irreversible electroporation (IRE)-ablation induced nanopores on the plasma membrane of hepatocytes.

Materials And Methods: On animal research committee approval, four New Zealand rabbits and two Yorkshire swine underwent IRE ablation of the liver (90 pulses, 100 μs per pulse at 2,500 V), and selected ablated liver tissues were harvested, fixed, and air-dried according to the electron microscopy (EM) protocol. A scanning electron microscope (SEM; Nova 230 NanoSEM [FEI, Hillsboro, Oregon] with 80 picoamperes and 10-kV acceleration) was used to visualize and verify IRE-created nanopores.

Prophylactic embolization of the cystic artery before radioembolization: feasibility, safety, and outcomes.

Purpose: To evaluate the safety and efficacy of two different methods of proximal cystic artery embolization in patients undergoing yttrium-90 radioembolization.

Materials And Methods: Forty-six patients had cystic artery embolization performed immediately before yttrium-90 radioembolization, either by using Gelfoam pledgets (n = 35) or coils (n = 11). Clinical symptomatology during the admission and angiographic findings at 1-month follow-up were retrospectively reviewed.

Image-guided tumor ablation: emerging technologies and future directions.

As the trend continues toward the decreased invasiveness of medical procedures, image-guided percutaneous ablation has begun to supplant surgery for the local control of small tumors in the liver, kidney, and lung. New ablation technologies, and refinements of existing technologies, will enable treatment of larger and more complex tumors in these and other organs. At the same time, improvements in intraprocedural imaging promise to improve treatment accuracy and reduce complications.

Percutaneous ablation of hepatocellular carcinoma: current status.

Hepatocellular carcinoma (HCC) is an increasingly common disease with dismal long-term survival. Percutaneous ablation has gained popularity as a minimally invasive, potentially curative therapy for HCC in nonoperative candidates. The seminal technique of percutaneous ethanol injection has been largely supplanted by newer modalities, including radiofrequency ablation, microwave ablation, cryoablation, and high-intensity focused ultrasound ablation.

Advanced hepatic ablation technique for creating complete cell death: irreversible electroporation.

Purpose: To evaluate the effectiveness of irreversible electroporation (IRE) in hepatic tissue ablation and the radiologic-pathologic correlation of IRE-induced cell death.

Materials And Methods: On approval of the animal research committee, 16 Yorkshire pigs underwent ultrasonography (US)-guided IRE of normal liver. A total of 55 ablation zones were created, which were imaged with US, magnetic resonance (MR) imaging, and computed tomography (CT) and evaluated with immunohistochemical analysis, including hematoxylin-eosin (H-E), Von Kossa, and von Willibrand factor (vWF) staining and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay.

Cryoablation of osteoid osteoma: two case reports.

Contemporary treatment of osteoid osteoma involves percutaneous imaging-guided therapy. Radiofrequency ablation (under computed tomographic guidance) remains the standard of care. Herein, the authors describe the successful treatment of two osteoid osteomas by using percutaneous cryoablation in difficult-to-access areas.

A new wave in treatment of vascular occlusive disease: biodegradable stents--clinical experience and scientific principles.

Stent-based therapies in percutaneous vascular intervention are associated with significant long-term complications related to in-stent restenosis. A growing body of literature demonstrates the feasibility of biodegradable materials for endovascular stents, which may, in theory, circumvent many of the immunologic and inflammatory response issues seen with long-term metallic stent failure in coronary and peripheral applications. This review describes the history of endovascular stents and the challenges encountered with metallic, drug-eluting, and biodegradable stents.

Bronchial and pulmonary arterial and venous interventions.

With advancement of interventional techniques and increasing complexity of patients, the involvement of interventional radiologists in the pulmonary critical care (PCC) setting has increased in recent years. Particularly, interventional radiologists have evolved to play a significant role in treating patients with vascular pathologies such as massive pulmonary embolism. In this article, we discuss management of these critically ill patients using four pulmonary and bronchial vascular interventional procedures: bronchial artery embolization in the setting of hemoptysis; pulmonary artery embolization in the setting of the treatment of AVM; thrombectomy and thrombolysis of the pulmonary arteries for the treatment of pulmonary embolism; and catheter-directed stent placement in the treatment of superior vena cava syndrome.

Emergency retrieval of a G2 filter after complete migration into the right ventricle.

A G2 inferior vena cava filter migrated completely into the right ventricle, resulting in chest pain, ventricular tachycardia, and hypotension in a 63-year-old man. Due to the filter's position, the patient was at high risk for further life-threatening cardiopulmonary complications. Percutaneous filter retrieval was successfully performed as a less-invasive alternative to open cardiothoracic surgery.

Imaging guided percutaneous irreversible electroporation: ultrasound and immunohistological correlation.

Preliminary results of percutaneous irreversible electroporation (PIE) on swine liver as a novel non-thermal ablation are presented. The goal of this study was to evaluate the feasibility of using irreversible electroporation in more clinically applicable manner, a percutaneous method, and to investigate a possible role of apoptosis in PIE-induced cell death. We performed PIE on four swine livers under real-time ultrasound guidance.

Retrieval of trapped Günther Tulip inferior vena cava filters: snare-over-guide wire loop technique.

The Günther Tulip inferior vena cava (IVC) filter is designed for transjugular retrieval with use of a sheath and snare device. This report describes a technique for removal of difficult-to-retrieve Günther Tulip IVC filters when the standard method fails. In a series of four patients, each with an IVC filter refractory to capture by snare alone, the use of a snare-over-guide wire loop technique succeeded in retrieving the filter in all cases.