Authors: Shivank Bhatia, MD, Sardis H. Harward, MPH, Vishal K. Sinha, BS, and Govindarajan Narayanan, MD
By: Sangik Park, MD, Ji Hoon Shin, MD, Dong-Il Gwon, MD, Hyoung Jung Kim, MD, Kyu-Bo Sung, MD, Hyun-Ki Yoon, MD, Gi-Young Ko, MD, and Heung Kyu Ko, MD
Abstract: To evaluate outcomes of transcatheter arterial embolization (TAE) for gastric cancer-related gastrointestinal (GI) bleeding and factors associated with successful TAE and improved survival after TAE.
Materials and Methods: This retrospective study included 43 patients with gastric cancer related GI bleeding undergoing angiography between January 2000 and December 2015. Clinical course, laboratory findings, and TAE characteristics were reviewed. Technical sucess of TAE was defined as target area revascularization, and clinical success was defined as bleeding cessatation with hemodynamic stability during 72 hours after TAE. Student t test was used for comparison of continuous variables, and Fischer exact test was used for categorical variables. Univariate and multivariate analysis were performed to identify predictors of successful TAE and 30-day survival after TAE.
Results: TAE was performed in 40 patients. Technical and clinical success rates of TAE were 85.0% and 65.0%, respectively. Splenic infarction occured in 2 patients as a minor complication. Rebleeding after TAE occured in 7 patients. Death related to bleeding occured in 5 patients. Active bleeding and higher transfusion requirement were associated with TAE failure. Successful TAE predicted improved 30-day survival after TAE on univariate and multiraviate analysis.
Conclusion: TAE for gastric cancer-associated GI bleeding may be a lifesaving procedure. Severe bleeding with a higher transfusion requirement and active bleeding on angiography predicted TAE failure.
Purpose: To evaluate efficacy and safety of a novel device that combines an inferior vena cava (IVC) filter and central venous catheter
(CVC) for prevention of pulmonary embolism (PE) in critically ill patients.
Materials and Methods: In a multicenter, prospective, single-arm clinical trial, the device was inserted at the bedside without fluoroscopy and subsequently retrieved before transfer from the intensive care unit (ICU). The primary efficacy endpoint was freedom from clinically significant PE or fatal PE 72 hours after device removal or discharge, whichever occurred first. Secondary endpoints were incidence of acute proximal deep venous thrombosis (DVT), catheter-related thrombosis, catheter-related bloodstream infections, major bleeding events, and clinically significant thrombus (occupying > 25% of volume of filter) detected by cavography before retrieval.
Results: The device was placed in 163 critically ill patients with contraindications to anticoagulation; 151 (93%) were critically ill trauma patients, 129 (85%) had head or spine trauma, and 102 (79%) had intracranial bleeding. The primary efficacy endpoint was achieved for all 163 (100%) patients (95% confidence interval [CI], 97.8%–100%, P < .01). Diagnosis of new or worsening acute proximal DVT was time dependent with 11 (7%) occurring during the first 7 days. There were no (0%) catheter-related bloodstream infections. There were 5 (3.1%) major bleeding events. Significant thrombus in the IVC filter occurred in 14 (8.6%) patients. Prophylactic anticoagulation was not initiated for a mean of 5.5 days ± 4.3 after ICU admission.
Conclusions: This novel device prevented clinically significant and fatal PE among critically ill trauma patients with low risk of complications.
Purpose: To retrospectively evaluate the results of endovascular therapy of vascular malformations principally treated with ethanol embolization at a single center.
Materials andMethods: From May1999 to December 2012, 46 patients (28 female,18 male) with vascular malformations (31 venous malformations,15 arteriovenousmalformations [AVMs]) throughout the body (nine upper extremity,31 lower extremity, and six truncal)who underwent ethanol embolization were studied and followed up. Demographic factors, clinical findings, imaging data, and patient reported changes in symptoms were collected and analyzed. Follow-up data were obtained by office visits,repeatimaging, and telephone contact.
Results: Twenty-four patients (52.2%)were considered cured,12 (26.1%) showed improvement, and 10 (21.7%) had no change or showed worsening. Similar rates of cure or improvement were seen for AVMs and venous malformations (P ¼ 0.67). Lesion location, depth, and size were not associated with differences in outcomes (P ¼ .87, P ¼ .37, and P ¼ .61, respectively). Type 1 and type 2 AVMs were cured more often than other AVM types. The overall complication rate was 24% (11 of 46 patients). Minor complications were seen in six individuals (13%), and major complications developed in five patients (11%).
Conclusions: Ethanol embolization of vascular malformations produces good outcomes, with control or relief of symptoms in a majority of patients
Purpose: To identify and compare predictors of local tumor progression (LTP)-free survival (LTPFS) after radiofrequency (RF) ablation and microwave (MW) ablation of colorectal liver metastases (CLMs).
Materials and Methods: This is a retrospective review of CLMs ablated from November 2009 to April 2015 (110 patients). Margins were measured on contrast-enhanced computed tomography (CT) 6 weeks after ablation. Clinical and technical predictors of LTPFS were assessed using a competing risk model adjusted for clustering.
Results: Technique effectiveness (complete ablation) was 93% (79/85) for RF ablation and 97% (58/60) for MW ablation (P 1⁄4 .47). The median follow-up period was significantly longer for RF ablation than for MW ablation (56 months vs. 29 months) (P < .001). There was no difference in the local tumor progression (LTP) rates between RF ablation and MW ablation (P 1⁄4 0.84). Significant predictors of shorter LTPFS for RF ablation on univariate analysis were ablation margins 5 mm or smaller (P < .001) (hazard ratio [HR]: 14.6; 95% confidence interval [CI]: 5.2–40.9) and perivascular tumors (P 1⁄4 .021) (HR: 2.2; 95% CI: 1.1–4.3); both retained significance on multivariate analysis. Significant predictors of shorter LTPFS on univariate analysis for MW ablation were ablation margins 5 mm or smaller (P < .001) (subhazard ratio: 11.6; 95% CI: 3.1–42.7) and no history of prior liver resection (P < .013) (HR: 3.2; 95%: 1.3–7.8); both retained significance on multivariate analysis. There was no LTP for tumors ablated with margins over 10 mm (median LTPFS: not reached). Perivascular tumors were not predictive for MW ablation (P 1⁄4 .43).
Conclusions: Regardless of the thermal ablation modality used, margins larger than 5 mm are critical for local tumor control, with no LTP noted for margins over 10 mm. Unlike RF ablation, the efficiency of MW ablation was not affected for perivascular tumors.
By: Jo~ao Pisco, MD, PhD, Tiago Bilhim, MD, PhD, Nuno V. Costa, MD, Manuel Pinto Ribeiro, MD, Lucia Fernandes, MD, and Antonio G. Oliveira, MD, PhD
The AVIR is pleased to announce that our Annual VI Board Prep course, offered at our annual meeting each year, is now available as an online webinar.
The VI Review Course includes access to the online lecture, as well our proprietary mock registry exam. The 4 hour lecture covers all sections of the exam matrix provided by ARRT.
This course is approved for 4 CE credits.