Mechanical clot disruption during pulmonary thromboembolectomy is safe: A propensity score-matched analysis.

Purpose: Aspiration thromboembolectomy is effective for treatment of high and intermediate-high risk pulmonary emboli (PE) but can be challenging when organized thrombus is present. Maceration using an expandable nitinol disk may be useful in these situations, but its safety has not been determined. The purpose of this study was to retrospectively assess the safety of this device when applied in the pulmonary vasculature, using a propensity-score matched group for comparison.

Suction thrombectomy for management of pulmonary tumor embolism in the setting of hepatocellular carcinoma with macrovascular invasion.

Pulmonary tumor thrombi are rare but challenging to treat given the generally poor health of the patients in whom they occur and the low likelihood of the embolism to respond to anticoagulation. Management options include therapeutic anticoagulation and surgery, but the mortality rate is high in either case. Thus, in patients who are symptomatic, the decision about whether to intervene may be challenging.

The Predictive Value of Qanadli and Miller Index Scores in Patients with Intermediate-High-Risk and High-Risk Pulmonary Emboli Undergoing Aspiration Thrombectomy.

Purpose: To evaluate the correlation between clot burden and pulmonary artery pressures in patients undergoing suction thromboembolectomy for high-risk and intermediate-high-risk pulmonary embolism with secondary outcomes of 30-day mortality and intensive care unit (ICU) length of stay.

Materials And Methods: Institutional review board (IRB) exemption was granted for this retrospective study. The charts of 120 consecutive patients who underwent mechanical thromboembolectomy using the Flowtriever system (Inari Medical, Irvine, California) between February 2020 and August 2022 were retrospectively reviewed, and the following data were collected: (a) preprocedural B-type natriuretic peptide and creatinine levels, (b) echocardiographic findings, (c) preprocedural and postprocedural pulmonary artery pressures, (d) ICU length of stay, and (e) 30-day mortality.

Effect of Filtered Blood Return on Outcomes of Pulmonary Aspiration Thrombectomy.

Objectives: To assess the effects of filtered blood reinfusion (FBR) on procedural outcomes of aspiration thrombectomy for pulmonary embolism (PE).

Materials And Methods: A total of 171 patients who underwent aspiration thrombectomy for intermediate-high-risk or high-risk PE between December 2018 and September 2022 were included, 84 of whom underwent thrombectomy with FBR and 87 without. Demographic data, vital signs, laboratory values, procedural details, pulmonary arterial pressures, transfusion needs, length of hospital stay, and procedure-related adverse events were recorded.

Image-guided percutaneous strategies to improve the resectability of HCC: Portal vein embolization, liver venous deprivation, or radiation lobectomy?

Despite considerable advances in surgical technique, many patients with hepatic malignancies are not operative candidates due to projected inadequate hepatic function following resection. Consequently, the size of the future liver remnant (FLR) is an essential consideration when predicting a patient's likelihood of liver insufficiency following hepatectomy. Since its initial description 30 years ago, portal vein embolization has become the standard of care for augmenting the size and function of the FLR preoperatively.

Reverse sheathing technique for iliocaval thrombectomy in the setting of IVC filters.

The Inari ClotTriever system (Inari Medical, Irvine, California) is safe and effective for the treatment of DVT. However, because it consists of a 31 cm coring device and collection bag that must be extended for use, application may be precluded by available intravascular "running room", such as in the presence of an IVC filter. Here we present a technique for bypassing IVC filters via retrograde deployment of the ClotTriever within a sheath, as illustrated in three cases.

Bladder-Induced Compression of the External Iliac Veins: Recognition and Implications for Treatment.

The effect of changes in bladder volume on the caliber of adjacent veins is underappreciated but essential to recognize to avoid complications such as unnecessary stenting or clot migration causing pulmonary embolism. Here the authors illustrate the importance of this finding in 3 cases using venographic and endovascular sonographic imaging: the first in which BPH-induced chronic bladder outlet obstruction resulted in DVT formation, the second in which the cause was unrecognized and unnecessary stenting performed, and the third in which inappropriate treatment was avoided by decompressing the bladder.

Use of a funneled sheath for embolic protection during removal of thrombosed Simon Nitinol filters.

Inferior vena cava (IVC) filters should be removed when no longer needed, given their association with complications such as thrombosis of the IVC and lower extremities, fracture, migration, and growth into adjacent structures. While this is generally straightforward in the setting of retrievable filters, permanent filters present more of a challenge. In fact, many operators will not attempt to do so for fear of intraprocedural complications, among them, filter fracture and fragment embolization.

Large left varicocele in a patient with portal hypertension treated via transjugular intrahepatic portosystemic shunt placement and both variceal and varicocele embolization.

Background: Scrotal swelling from varicocele is a common complaint in adult men. Varicocele due to portosystemic collaterals is a rare presentation of portal hypertension. Imaging workup and intervention for varicocele in this case is more complex than varicocele due to absent or incompetent valves in the testicular veins and pampiniform plexus.

Direct superior vena cava puncture for inferior vena cava filter retrieval.

Most inferior vena cava (IVC) filters are designed for retrieval from a superior approach. Retrieval becomes technically challenging when the central veins in the chest are occluded. In a patient with thrombosis of the bilateral brachiocephalic veins, the authors describe direct puncture of the superior vena cava (SVC) under fluoroscopy, followed by the successful retrieval of a fractured IVC filter using forceps.

Suction thrombectomy of catheter-associated right atrial thrombus in two patients.

Catheter associated right atrial thrombus (CRAT) is an uncommon but potentially life-threatening condition. There are no established guidelines for management, and treatment ranges from systemic anticoagulation and thrombolysis to open surgery. While there have been reports on use of suction thrombectomy for right atrial thrombi, the feasibility and outcomes of suction thrombectomy in CRAT have not been described.

Development of paravertebral pseudoaneurysms following vertebral augmentation: a report of two cases.

Paravertebral pseudoaneurysms are infrequent following vertebral augmentation but can be difficult to manage due to their proximity to the arterial supply of the spinal cord. Here, we present two distinct manifestations of this complication with associated anatomy and management. In the first, a pseudoaneurysm developed following radiofrequency ablation and kyphoplasty at the L2 and L4 levels.

Bronchial artery embolization for hemoptysis in a postpartum patient via cesarean section with COVID-19 while on extracorporeal membrane oxygenation.

Although COVID-19 coagulopathy typically manifests with thrombotic complications, hemorrhagic complications also occur and must be considered when making decisions about anticoagulation in these patients. Here, we report a case of massive hemoptysis occurring in a recently post-partum woman via Cesarean section with COVID-19 who was managed via bronchial artery embolization while on extracorporeal membrane oxygenation.

Balloon-assisted radioembolization via the proper hepatic artery to treat a left liver hepatocellular carcinoma and portal vein tumor thrombus with an inaccessible left hepatic artery: A case report.

Although yttrium-90 (Y) transarterial radioembolization (TARE) is an effective treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT), inability to cannulate tumor-feeding vessels can preclude its use. In this case we demonstrate the feasibility of employing balloon occlusion within the proper hepatic artery to treat a left lobar HCC and PVTT with an inaccessible left hepatic artery. Vessel angulation prevented subselection of the left hepatic artery, and subsequent mapping studies indicated significant non-target radiotracer activity.

Genicular Artery Embolization for Refractory Hemarthrosis following Total Knee Arthroplasty: Technique, Safety, Efficacy, and Patient-Reported Outcomes.

Purpose: To investigate the safety and efficacy of genicular artery embolization for treatment of refractory hemarthrosis following total knee arthroplasty.

Material And Methods: Patients who underwent genicular artery embolization with spherical embolics between January 2010 and March 2020 at a single institution were included if they had undergone total knee arthroplasty and subsequently experienced recurrent hemarthrosis. Technical success was defined as the significant reduction or elimination of the hyperemic blush.

A Novel Treatment for Metastatic Serous Cystadenocarcinoma Using a Microwave Ablation: Case Report and Review of the Literature.

The incidence of pancreatic cystic neoplasms has grown because of increased detection. Among these lesions, serous cystadenoma was traditionally thought to be universally benign and indolent. However, there is an exceedingly rare malignant variant of serous cystadenoma known as serous cystadenocarcinoma (SCAC) that can exhibit local invasion into adjacent structures, hepatic implants, and metastatic spread to the abdominal viscera.

Combination uterine artery embolization and hysteroscopic resection for a symptomatic uterine leiomyoma: A collaborative single-session approach for better patient care.

Uterine artery embolization (UAE) for symptomatic uterine fibroids is accompanied by transcervical fibroid expulsion in 3-15% of cases. It can be a source of significant patient distress, may require reintervention for removal, and is the most common reason for hospital readmission following UAE. Conversely, the success of hysteroscopic resection decreases with increasing fibroid size while the risk of complications increases.

Management of Refractory Ascites Due to Portal Hypertension: Current Status.

Refractory ascites is a costly and debilitating condition that occurs most frequently in the setting of substantial cirrhotic portal hypertension, where it portends a poor prognosis. Many treatment options are available, among them medical management, serial large volume paracenteses, transjugular intrahepatic portosystemic shunts, and implanted drainage devices. Although the availability of multiple therapies ensures that most patients will achieve satisfactory results, it can be challenging for the provider to select the appropriate treatment for each specific patient.

Mechanical thrombectomy for pulmonary embolism in patients with patent foramen Ovale.

Background: The current level of evidence for mechanical thrombectomy (MT) of pulmonary embolism (PE) in patients with patent foramen ovale (PFO) is limited.

Results: This was a retrospective analysis of 9 patients with PFO and acute high-risk or intermediate-high-risk PE, 6 with intermediate-high risk and 3 with high-risk PE. All underwent MT using the Inari FlowTriever System from Dec 2018 to November 2019.