Transradial versus transfemoral arterial access in the uterine artery embolization of fibroids

Purpose: Transradial arterial access has become more popular in body interventional procedures but has not been ubiquitously adapted. This retrospective study assesses the efficacy of this approach in uterine artery embolization. Aim of the study was to compare transradial to transfemoral arterial access in patients undergoing uterine artery embolization for the treatment of fibroids. Material and methods: A total of 172 patients underwent uterine artery embolization procedures at our institute from October 2014 to June 2020. Of these, 76 patients had their operations performed via transfemoral access while 96 underwent transradial access. The peak radiation dose, fluoroscopy time, procedure time, total contrast volume, and equipment cost for each procedure were all reviewed to evaluate for statistical differences between the 2 groups. Results: All cases were technically successful without major complications. The average peak skin dose was 2281 mGy, with no statistical difference between the transradial or transfemoral cohorts. Average fluoroscopy time was 25 minutes, also with no statistical difference between the subsets. Mean procedure time was 100 min, and mean contrast volume usage was 138 mL with no statistical differences. Similarly, the average equipment cost was $2204, with no significant differences found between transradial and transfemoral access. Conclusions: With respect to many pertinent radiation parameters, transradial access was evaluated as being an equally efficacious alternative to transfemoral access in uterine artery embolization procedures. The results of this study suggest that transradial access should be considered more often, whenever viable, as an option in the uterine artery embolization treatment of fibroids

Radioembolization with Yttrium-90 Microspheres for the Treatment of Liver Metastases of Pancreatic Adenocarcinoma: A Multicenter Analysis.

PURPOSE: To retrospectively assess the efficacy and safety of radioembolization with yttrium-90 ( MATERIALS AND METHODS: Thirty-three patients with metastatic pancreatic adenocarcinoma that progressed despite systemic chemotherapy and other treatments directed at primary tumors and metastases were treated with RESULTS: Imaging results showed partial response in 8 patients (42%), stable disease in 7 (37%), and progressive disease in 4 (21%). Median overall survival times after radioembolization and diagnosis of the primary tumor were 8.1 (95% CI, 4.8-12.5) and 20.8 (95% CI, 14.2-29.0) months, respectively. Radioembolization did not produce major hepatic toxicity, and changes in liver enzyme levels were rarely grade ≥ 3 during the 12-week follow-up. The exceptions were 3 patients with grade 3 increased alkaline phosphatase (week 2) and bilirubin levels (week 4), increased bilirubin level (week 12), and decreased albumin level (week 12), respectively. Most reported complications were grade ≤ 2, with 2 patients showing short-term radioembolization-related grade 3 abdominal distention, abdominal pain, fatigue, or ascites. CONCLUSIONS: Yttrium-90 radioembolization provided a meaningful survival benefit in patients with liver metastases from pancreatic adenocarcinoma that progressed despite previous therapies. Adverse events and liver toxicity were tolerable and only occasionally severe (grade ≥ 3)

Use of the gun-sight technique to create a parallel transjugular intrahepatic portosystemic shunt

A parallel shunt (PS) is often necessary to regain portal decompression in a dysfunctional transjugular intrahepatic portosystemic shunt (TIPS). Here, we successfully utilized the gun-sight technique to create a PS. An 81-year-old male with decompensated NASH cirrhosis and recent TIPS placement presents with recurrent ascites and pleural effusions in the setting of a persistent portosystemic gradient. Due to a lack of access to endovascular ultrasound and complex patient anatomy, a gun-site technique was approached to create a PS (left portal vein [PV] to left hepatic vein [HV]). After the right HV and existing TIPS were accessed via the right internal jugular vein access, the left HV was accessed. Following a left portal venogram, 10 mm snares were placed into the left HV and the left PV. An 18-gauge needle was then fluoroscopically placed through and through both snares. A 0.035 Glidewire was snared with the help of both snares, establishing access from the left HV via the left PV to the right PV. After serial dilation, a roadrunner wire and catheter were placed into the main PV and superior mesenteric vein, followed by stent dilation. Post-TIPS portal venogram showed prompt flow of contrast from the main PV to the right atrium without any stenosis through both TIPS stents in the left and right PVs. Initial and postprocedural TIPS gradients were 24 mm Hg and 6 mm Hg, respectively. Gun-site technique is a valuable technique in creating a parallel TIPS shunt

Geophysical and Geochemical Characterization of Solidwaste Dumpsite: A Case Study of Chowa Gujar, Peshawar (Part of Indus Basin)

Open and non-engineered dumping is a typical method for solid waste disposal in most cities of Pakistan. This practice of waste dumping poses a serious threat to the surrounding ecosystem and human population due to the release and transport of decomposed organic matter, i.e., leachate from dumpsite into the groundwater. The present study was conducted over a non-engineered and open dumpsite (Chowa Gujar), located in the outskirts of the highly populated city of Peshawar by using integrated geophysical techniques such as electrical resistivity tomography (ERT) and ground-penetrating radar (GPR) and geochemical techniques. The main goal was to delineate the characterization and depth of buried waste, to map the subsurface extension of contaminant plumes towards agricultural land and groundwater table and the concentration of heavy metals (HMs) in dump and agricultural soil. Geophysical results showed that the thickness of buried waste (predominantly composed of domestic waste) was around 4 m and the leachate plumes have percolated to the adjacent agricultural land. A range of heavy metals (mg/kg) such as Cr (20.5–26.6), Cd (2.6–5.7), Pb (0.35–21.25), Ni (2.5–53.05), Cu (29–68.3), Zn (45.7–77), and Co (18.9–23.2) have been found in the agricultural land adjacent to the dumpsite. The findings demonstrated that combined use of ERT and GPR successfully characterize the buried waste and spread of pollutant plumes spatially and vertically from Chowa Gujar dumpsite. The anomalous geophysical signatures were confirmed by geochemical characterization. The movement of leachate plumes towards agricultural land and groundwater table and the concentration of HMs in soil show that Chowa Gujar dumpsite is a potential source of contamination not only to the surrounding population but also to the agricultural land, surface (Bara River), and subsurface water bodies. In the study region, there is an urgency to take remediation and mitigation measures to reduce the level of pollution created by the dumpsite

Geophysical and Geochemical Characterization of Solidwaste Dumpsite: A Case Study of Chowa Gujar, Peshawar (Part of Indus Basin)

Open and non-engineered dumping is a typical method for solid waste disposal in most cities of Pakistan. This practice of waste dumping poses a serious threat to the surrounding ecosystem and human population due to the release and transport of decomposed organic matter, i.e., leachate from dumpsite into the groundwater. The present study was conducted over a non-engineered and open dumpsite (Chowa Gujar), located in the outskirts of the highly populated city of Peshawar by using integrated geophysical techniques such as electrical resistivity tomography (ERT) and ground-penetrating radar (GPR) and geochemical techniques. The main goal was to delineate the characterization and depth of buried waste, to map the subsurface extension of contaminant plumes towards agricultural land and groundwater table and the concentration of heavy metals (HMs) in dump and agricultural soil. Geophysical results showed that the thickness of buried waste (predominantly composed of domestic waste) was around 4 m and the leachate plumes have percolated to the adjacent agricultural land. A range of heavy metals (mg/kg) such as Cr (20.5–26.6), Cd (2.6–5.7), Pb (0.35–21.25), Ni (2.5–53.05), Cu (29–68.3), Zn (45.7–77), and Co (18.9–23.2) have been found in the agricultural land adjacent to the dumpsite. The findings demonstrated that combined use of ERT and GPR successfully characterize the buried waste and spread of pollutant plumes spatially and vertically from Chowa Gujar dumpsite. The anomalous geophysical signatures were confirmed by geochemical characterization. The movement of leachate plumes towards agricultural land and groundwater table and the concentration of HMs in soil show that Chowa Gujar dumpsite is a potential source of contamination not only to the surrounding population but also to the agricultural land, surface (Bara River), and subsurface water bodies. In the study region, there is an urgency to take remediation and mitigation measures to reduce the level of pollution created by the dumpsite