Publications by authors named "Justin P McWilliams"
A new conformable embolic agent, brand name Obsidio (Boston Scientific Inc), is indicated for embolizing hypervascular tumors and treating peripheral vessel bleeding. It is a non-Newtonian hydrogel that becomes less viscous when shear force is applied. This retrospective study examines the safety and effectiveness of the shear-thinning embolic in a single-academic-center experience.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to link the histopathologic grade of LI-RADS 5 hepatocellular carcinoma (HCC) from preablation needle biopsies to outcomes like local tumor control and overall survival post-thermal ablation.
- It involved 133 adult patients with confirmed LI-RADS 5 HCC, finding no difference in local tumor control rate, but poorly differentiated tumors showed significantly worse intrahepatic progression-free survival and lower overall survival compared to better-differentiated ones.
- The results suggest that patients with poorly differentiated LI-RADS 5 HCC face greater challenges in preventing tumor progression after thermal ablation compared to those with well- or moderately differentiated tumors.
Purpose This study aimed to determine the costs associated with prostatic artery embolization (PAE) performed in hospital and outpatient-based lab (OBL) settings. Methods Procedures were performed in similarly equipped procedure suites located within a tertiary hospital or OBL. Time-driven activity-based costing (TDABC) was utilized to calculate procedural costs incurred by the institution.
View Article and Find Full Text PDFPurpose: To describe clinical outcomes among patients with benign prostatic hyperplasia (BPH) 24 months following prostatic artery embolization (PAE).
Materials And Methods: This was an international, multicenter, prospective trial of males with BPH with lower urinary tract symptoms (LUTS) or acute urinary retention (AUR) treated with PAE. The primary outcome was the 12 month change in the International Prostate Symptom Score (IPSS) for patients referred for bothersome LUTS, or urinary catheter independence for patients treated for AUR.
Embolization of de novo pulmonary arteriovenous malformations (PAVMs) using high-volume detachable non-fibered (HVDNF) coils was compared to traditional non-HVDNF coils. Persistent-occlusion rates were evaluated. A total of 272 de novo (previously untreated) PAVM treatments were retrospectively stratified into those treated with non-HVDNF coils only ( = 192) and those treated with HVDNF coils with or without other coils ( = 80).
View Article and Find Full Text PDFPurpose: To evaluate the efficacy of combination therapy using transarterial chemoembolization with microwave ablation (MWA) therapy vs. MWA monotherapy for hepatocellular carcinomas (HCCs) >3 cm in size.
Methods: This two-arm retrospective observational study included patients with HCCs >3 cm who underwent either combination therapy (29 patients) or MWA monotherapy (35 patients) between 2014 and 2020.
Background: Although non-target puncture (NPT)-related complications are well known to clinicians performing TIPS, there is no NTP-focused study to assess the true clinical sequalae of NTP-related complications. In this study, the aim was to evaluate the incidence, safety, clinical outcomes and complications related to NTPs during the portal access of TIPS procedures.
Methods: A retrospective review of 369 TIPS procedures from October 2007 to September 2019 was performed.
Purpose: To compare the performance of a prototype high-flow catheter connector, the Lamprey Lock, with that of a conventional Luer connector.
Materials And Methods: The Lamprey Lock was created to eliminate the choke point resulting from Luer connections by achieving a cross-sectional area approximately 2.5 times larger than that achieved by a conventional Luer connector.
Pulmonary arteriovenous malformations develop in approximately 50% of hereditary hemorrhagic telangiectasia patients. Pulmonary arteriovenous malformations are often treated with coil embolization therapy. We report a case of a 45-year-old female with multiple pulmonary arteriovenous malformations due to underlying hereditary hemorrhagic telangiectasia who had undergone 14 coil embolization procedures over 16 years.
View Article and Find Full Text PDFBackground: We describe the treatment of a renal artery aneurysm with complex anatomy using coils and the PipelineTM Embolization Device (Medtronic, Irvine, CA), a flow-diverting stent typically used for the treatment of intracranial aneurysms.
Methods: A 62-year-old female with history of an asymptomatic right renal artery aneurysm that was discovered incidentally 10 years ago was found to have enlargement of the aneurysm (1.9cm to 2.
Purpose: The aim of this study was to investigate whether prostatic artery embolization (PAE) can be considered a long-term cost-effective treatment option in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia in comparison to transurethral resection of the prostate (TURP).
Methods: The in-hospital costs of PAE and TURP in the United States were obtained from a recent cost analysis. Clinical outcomes including nature and rate of adverse events for TURP and PAE along with rates of retreatment because of complications or clinical failure were obtained from peer-reviewed literature.
Purpose: To determine the prevalence of adverse events after image-guided biopsy of histologically proven hepatocellular carcinomas (HCC) using a standardized, indirect access, coaxial biopsy technique.
Methods: In this IRB-approved, HIPAA compliant, and retrospective study, we evaluated all consecutive adult patients from 2011 to 2016 who underwent image-guided biopsy of HCC with and without concurrent ablation. Tumor seeding was defined as any new lesion along the needle tract on subsequent imaging.
Objectives: To investigate the usefulness of minimal ablative margin (MAM) control by intra-procedural contrast-enhanced CT (CECT) in microwave ablation (MWA) of liver tumors.
Methods: A total of 334 consecutive liver tumors (240 hepatocellular carcinomas [HCCs] and 94 colorectal liver metastases [CRLMs]) in 172 patients treated with percutaneous MWA were retrospectively included. MAM of each tumor was assessed after expected ablation completion using intra-procedural CECT, allowing within-session additional ablation to any potentially insufficient margin.
Background: Hereditary hemorrhagic telangiectasia (HHT) is a vascular bleeding disorder characterized by mucocutaneous telangiectasias and visceral arteriovenous malformations. A frequently debilitating symptom is spontaneous recurrent epistaxis.
Objective: To evaluate whether doxycycline therapy improves epistaxis in HHT by using a prospective, randomized, placebo-controlled crossover study design.
Background: Hepatic arteriovenous malformations (AVMs) in hereditary hemorrhagic telangiectasia (HHT) patients are most commonly hepatic artery to hepatic venous shunts which can result in high-output heart failure. This condition can be debilitating and is a leading cause of liver transplantation in HHT patients. However, it is not known what characteristics can discriminate between asymptomatic patients and those who will develop heart failure symptoms.
View Article and Find Full Text PDFIntroduction: The purpose of this study was to investigate the rates of complications and diagnostic yield of transjugular liver biopsy (TJLB) in deceased donor liver transplant (DDLT) recipients.
Methods: From January 2009 to December 2019, 1,055 TJLBs were performed in 603 adult DDLT recipients with a mean age of 54 (±12 years). Data were retrospectively reviewed to determine the diagnostic efficacy and incidence of major and minor complications in the 3-day and 1-month period after TJLB.
Purpose: To perform a preliminary comparison of the sensitivity and positive predictive value of ferumoxytol-enhanced MR angiography with those of CT angiography for detection of pulmonary arteriovenous malformations (AVMs) in hereditary hemorrhagic telangiectasia (HHT).
Materials And Methods: Institutional review board approval and informed patient consent were obtained. Ten patients with pulmonary AVMs who had undergone CT of the chest within 12 months underwent MRI of the chest and abdomen with ferumoxytol at 3.
Purpose: To compare coil embolotherapy outcomes of feeding-artery-only versus nidus-plus-feeding-artery technique for treating pulmonary arteriovenous malformations (PAVMs).
Materials And Methods: A total of 219 treatment-naïve PAVMs embolized in 90 patients at a single center from 2008 to 2018 met inclusion criteria for retrospective evaluation. Of the patients, 87% had a diagnosis of hereditary hemorrhagic telangiectasia (HHT).
Purpose: To compare the performance of a dual-lumen flushable drainage catheter to a conventional catheter for complex fluid collection drainage.
Methods: Two prototype catheters (20- and 28-F) were created by incorporating a customized infusion lumen within the wall of a large-bore conventional drainage catheter, which facilitated simultaneous irrigation of the drainage lumen and the targeted collection via inward- and outward-facing infusion side holes. These were tested against unaltered 20- and 28-F conventional catheters to determine if the injection of a dedicated flush lumen improved rapidity and completeness of gravity drainage.