51 research outputs found
Editorial of Special Issue "Embolization Techniques: State of the Art and Future Perspectives"
Embolization is one of the most important applications in interventional radiology which can be mainly performed using an endovascular approach [...]
Plasma-mediated radiofrequency ablation followed by percutaneous cementoplasty under fluoro-CT guidance: a case report
We report a case of a 81-year-old Caucasian man with colorectal carcinoma, treated by surgery in 1998, referred for palliative treatment of a refractory painful caused by osteolytic metastases of 2.5 cm in back-upper ilium spine. Plasma-mediated radiofrequency ablation was performed under conscious sedation, using Fluoroscopic Computer Tomography guidance. After completing the ablation phase of the procedure, a mixture of bone cement and Biotrace sterile barium sulfate was injected into the ablated cavity
Ablation of painful metastatic bone tumors: A systematic review
AbstractThe pain is the most common problem in patients with bone metastases. It is not related to the characteristics of the tumor (type, location, number or size of metastases). Currently, the bone metastases can be treated with chemotherapy, hormonal therapy, surgery and radiotherapy, but the drugs most used in the treatment of pain are opioids. These drugs give benefit between 8 and 12weeks and often give non-negligible toxic effects. Percutaneous techniques are varied and, when there is indication, can be used to reduce pain and dose of morphine in these patients, being safe and effective techniques already at 4weeks of treatment.The choice of a methodical of ablation compared to another depends on the type, size and location of the lesion. Moreover, the combined treatments of ablation and cementoplastic are also useful to stabilize the bone lesion.This review article analyzes techniques and effectiveness of percutaneous treatments of skeletal metastases
Transcatheter Aortic Valve Implantation (TAVI) Planning with Dual-Layer Spectral CT Using Virtual Monoenergetic Image (VMI) Reconstructions and 20 mL of Contrast Media
Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical implantation and its implementation is progressively increasing worldwide. We routinely perform pre-procedural aortic angiography CT to assess aortic dimensions and vascular anatomy. This study aims to evaluate the image quality of CTA for TAVI planning using dual-layer spectral CT, with virtual monoenergetic image reconstructions at 40 keV. Thirty-one patients underwent a CTA protocol with the injection of 20 mL of contrast media. Image quality was assessed by measuring the mean density in Hounsfield Units (HU), the signal-to-noise ratio, and the contrast-to-noise ratio in VMI reconstructions. Additionally, a blinded subjective analysis was conducted by two observers. The results showed significant enhancement at all sampled vascular levels with a gradual decrease in HU from proximal to distal regions. Favourable subjective ratings were given for all parameters, with greater variability in the evaluation of iliac axes. A significant negative correlation (p < 0.05) was observed between BMI and CA at all vascular levels, indicating reduced contrast enhancement with increasing BMI. Spectral CT, along with reducing iodine load, allows for obtaining high-quality images without a significant increase in noise. The reduction in iodine load can have positive implications in clinical practice, improving patient safety and resource efficiency
Combined Trans-Arterial Embolization and Ablation for the Treatment of Large (>3 cm) Liver Metastases: Review of the Literature
Background: The aim of this review was to determine the state of clinical practice in the role of the combined approach of embolization and ablation in patients with secondary liver lesions greater than 3 cm who are not candidates for surgery, and to study its safety and efficacy. (2) Methods: Two reviewers conducted the literature search independently. Eight articles on the combined approach of embolization and ablation in secondary liver lesions were selected. (3) Results: The studies were published between 2009 and 2020. Two studies were prospective in design. The sample size was < 100 patients for all studies. All studies demonstrated the safety of the combined approach based on the low complication rate. Some studies lamented non-uniform systemic chemotherapy regimens and the variability in the sequence of embolization and ablation. (4) Conclusions: This review presents the combined approach of ablation and embolization in liver lesions greater than 3 cm as a safe therapeutic procedure with positive effects on patient survival. Prospective and multicentric studies are needed to further evaluate its efficacy
Basic embolization techniques: tips and tricks
Good knowledge of the various approaches of embolization of peripheral bleedings and different embolic materials available is of paramount importance for successful and safe embolization. We review and illustrate the main endovascular and percutaneous techniques used for embolization, along with the characteristics of the different embolic materials, and the potential complications
Virtual Non-Contrast Spectral CT in Renal Masses:Is It Time to Discard Conventional Unenhanced Phase?
A multicenter retrospective cohort study evaluating the clinical outcomes of patients with coagulopathy undergoing transcatheter arterial embolization (tae) for acute non-neurovascular bleeding
Background and Objectives: Transcatheter arterial embolization (TAE) is the mainstay of
treatment for acute major hemorrhage, even in patients with coagulopathy and spontaneous bleeding.
Coagulopathy is associated with worsening bleeding severity and higher mortality and clinical failure
rates. Furthermore, some unanswered questions remain, such as the definition of coagulopathy, the
indication for TAE or conservative treatment, and the choice of embolic agent. This study aims to
assess the efficacy and safety of TAE for spontaneous non-neurovascular acute bleeding in patients
with coagulopathy. Materials and Methods: This study is a multicenter analysis of retrospectively
collected data of consecutive patients with coagulopathy who had undergone, from January 2018
to May 2023, transcatheter arterial embolization for the management of spontaneous hemorrhages.
Results: During the study interval (January 2018–May 2023), 120 patients with coagulopathy underwent
TAE for spontaneous non-neurovascular acute bleeding. The abdominal wall was the most
common bleeding site (72.5%). The most commonly used embolic agent was polyvinyl alcohol (PVA)
particles or microspheres (25.0%), whereas coils and gelatin sponge together accounted for 32.5% of
the embolic agents used. Technical success was achieved in all cases, with a 92.5% clinical success rate
related to 9 cases of rebleeding. Complications were recorded in 12 (10%) patients. Clinical success
was significantly better in the group of patients who underwent correction of the coagulopathy within 24 h of TAE. Conclusions: Transcatheter arterial embolization (TAE) is effective and safe for
the management of acute non-neurovascular bleeding in patients with coagulopathy. Correction of
coagulopathy should not delay TAE and vice versa, as better clinical outcomes were noted in the
subgroup of patients undergoing correction of coagulopathy within 24 h of TAE
Endovascular treatment of visceral artery pseudoaneurysms with ethylene-vinyl alcohol (evoh) copolymer-based non-adhesive liquid embolic agents (naleas)
Background and Objectives: Treatment of visceral artery pseudoaneurysms (VAPs) is always
indicated regardless of their diameters, as their risk of rupture is significantly higher than that of
visceral artery aneurysms. The invasiveness of surgery and its associated complications have led
to a shift in favor of radiological interventions as the initial treatment of choice. However, there
are still some unanswered questions on endovascular treatment of VAPs regarding the optimal
endovascular technique and the efficacy and safety outcomes. The purpose of this multicenter
study was to retrospectively evaluate the effectiveness and safety of endovascular treatment of
visceral pseudoaneurysms using Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive
Liquid Embolic Agents (NALEAs). Materials and Methods: Consecutive patients who underwent
endovascular embolization with EVOH-based NALEAs for visceral artery pseudoaneurysms between
January 2018 and June 2023 were retrospectively evaluated. Results: 38 embolizations were performed.
Technical success was achieved in all patients. The clinical success rate was high (92.1% overall),
with no significant differences between ruptured and unruptured VAPs (p = 0.679). Seven patients
(18.4%) experienced procedure-related complications, related to one case of non-target embolization,
four splenic abscesses due to end-organ infarction, and two femoral pseudoaneurysms. The rates of
procedure-related complications, end-organ infarction, and vascular access-site complications did
not significantly differ between ruptured and unruptured VAPs (p > 0.05). Conclusions: Both ruptured
and unruptured visceral pseudoaneurysms can be effectively and safely treated with NALEA-based
endovascular embolization. We suggest considering the use of NALEAs, particularly in specific
clinical cases that highlight their advantages, including patients with coagulopathy, fragile vessels,
and embolization targets that are located at a considerable distance from the microcatheter tip and
are otherwise difficult to reach
Interventional Radiological Management and Prevention of Complications after Pancreatic Surgery: Drainage, Embolization and Islet Auto-Transplantation
Pancreatic surgery still remains burdened by high levels of morbidity and mortality with a relevant incidence of complications, even in high volume centers. This review highlights the interventional radiological management of complications after pancreatic surgery. The current literature regarding the percutaneous drainage of fluid collections due to pancreatic fistulas, percutaneous transhepatic biliary drainage due to biliary leaks and transcatheter embolization (or stent–graft) due to arterial bleeding is analyzed. Moreover, also, percutaneous intra-portal islet auto-transplantation for the prevention of pancreatogenic diabetes in case of extended pancreatic resection is also examined.
Moreover, a topic not usually treated in other similar reviewsas percutaneous intra-portal islet autotransplantation for the prevention of pancreatogenic diabetes in case of extended pancreatic resection is also one of our areas of focus. In islet auto-transplantation, the patient is simultaneously donor and recipient. Differently from islet allo-transplantation, it does not require immunosuppression, has no risk of rejection and is usually efficient with a small number of transplanted islets
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