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Objective: To determine the long-term results of patients undergoing transcatheter coil embolization for the treatment of acute colonic haemorrhage. Methods: Patients undergoing angiography for suspected colonic bleeding between January 2002 and December 2012 were reviewed (average age, 60 years; 38.4% male). Baseline, procedural and outcome parameters were recorded following the Society of Interventional Radiology guidelines. Primary outcome measures included early (< 30 days ) and delayed (> 30 days ) rebleeding events and adverse procedure-related complication. Average follow-up time was 996 days (median, 232 days; range, 30-3663 days). Results: One or multiple sites of bleeding were identified in 40 cases. Coil embolization was performed in 39 patients, 26 (66.7%, 26/39) of whom were treated successfully without technical/clinical failure (n = 12) or loss to follow-up (n = 1). Three patients (11.5%, 3/26) rebled in the early period within 30 days; one patient went on to hemicolectomy. Four patients (15.3%, 4 /26 ) experienced delayed rebleeding after 30 days; two of whom also underwent hemicolectomy. No major complication occurred. One minor complication of short segment arterial dissection was seen in the clinical failure group. One case of asymptomatic ischaemia was identified on a patient undergoing pre-operative colonoscopy for elective bowel resection. No instances of ischaemic stricture were seen. All-cause mortality of successfully treated and all patients at 1 year was 31% (8/26 ) and 30% (12/40), respectively. Conclusion: Transcatheter coil embolization is a durable treatment option with a technical and clinical success rate of 67% in the setting of acute colonic haemorrhage. A modest level of rebleeding was seen among successfully treated patients in both the early and delayed periods; in the majority of patients, embolization proved to be definitive therapy. Advances in knowledge: Transcatheter coil embolization is a durable and potentially definitive therapy in the management of acute colonic haemorrhage. [ABSTRACT FROM AUTHOR]

Endoleak is the most common complication after endovascular aneurysm repair. The most common type of endoleak, a type II endoleak, typically follows a benign course and is only treated when associated with increasing aneurysm size. In this case report, we describe a ruptured abdominal aortic aneurysm due to a late, type II endoleak occurring 10 years after endovascular aneurysm repair that was successfully treated by transarterial embolization. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether there is a cost advantage for one of the three commonly performed interventional radiology (IR) procedures (chemoembolization, selective internal radiation therapy [SIRT], radiofrequency ablation [RFA]) in the treatment of hepatocellular carcinoma (HCC). Materials and Methods: A cost analysis from the payer perspective was performed. Primary data were collected from a university hospital, and sensitivity testing was done by comparing coding information obtained at two other tertiary care medical facilities. Medicare allowable reimbursements were used to estimate costs. Decision analytic models using decision tree analysis and Monte Carlo simulations were used to compare alternatives. Simulations were performed comparing all three procedures, followed by a two-way comparison of chemoembolization and SIRT. Results: Simple decision tree analyses showed that RFA was less expensive compared with chemoembolization and SIRT. Monte Carlo simulations showed average reimbursements for each of the three procedures that was largely dependent on the number of repeat procedures required ($9,362 vs $30,107 vs $35,629 for RFA, chemoembolization, and SIRT; P < .001). When comparing only chemoembolization and SIRT, chemoembolization was the lower cost strategy in most scenarios, but SIRT was lower in cost in more than one-third of the simulations. Conclusions: RFA was the least costly of the three IR strategies in nearly all scenarios studied in these models. Although chemoembolization was less expensive than SIRT in most instances, Monte Carlo simulation showed a preference for SIRT in more than one-third of all scenarios. Sensitivity analyses showed that the most important variables assessed were the need for repeat procedures. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively review experience with difficult retrievals of Günther Tulip filters (GTFs) in which various techniques were used. Materials and Methods: From December 2004 to December 2006, 32 patients were referred to a single radiology department for GTF retrieval (25 women and seven men; mean age, 40 years; range, 21-60 y). All patients were evaluated, and 22 of these patients had undergone unsuccessful filter retrieval attempts elsewhere. In the remaining patients, significant tilt of the filter (n = 8) or difficult internal jugular vein access (n = 2) discouraged retrieval attempts. There were a total of 38 filters. Twenty-five patients had a filter in the infrarenal inferior vena cava (IVC). Among the remaining seven patients, six had bilateral iliac filters and one had a left iliac filter. Retrievals were performed via conventional technique-ie, by snaring the hook of the filter without additional maneuvers-or other techniques. Results: Thirty-seven of 38 filters were successfully removed, for a success rate of 97%. Successful retrievals were performed with conventional (n = 4), catheter twist (n = 3), modified snare (n = 15), loop snare (n = 14), and balloon dilation (n = 1) techniques. The average dwell time for filters successfully removed was 58 days (range, 22-258 d). One failure occurred in a patient who had undergone unsuccessful retrieval previously. The hook of the filter and a displaced secondary strut, which had migrated superiorly, were incorporated into the IVC wall in this case. Conclusions: Additional maneuvers were useful in these difficult retrievals of GTFs that might not otherwise be retrievable with the conventional method. [ABSTRACT FROM AUTHOR]

Purpose: To compare the complication rates of patients undergoing conventional lung biopsy to those undergoing core biopsy for genetic analysis. Materials and Methods: This study was approved by the Institutional Review Board at our institution. All patients who underwent standard diagnostic lung biopsy and lung biopsy for molecular marker analysis between 7/1/2011 and 6/30/2013 were retrospectively evaluated. Twenty-three patients had biopsies performed for genetic analysis (5 men, 18 women, mean age 67 years), and 173 patients underwent standard diagnostic lung biopsy (86 men, 87 women, mean age 68 years). All biopsies were performed under CT guidance using a coaxial technique (19 gauge introducer needle and 20 gauge core biopsy needle). Cytopathology was present for all cases and confirmed the adequacy of the samples. The number of core samples was noted for each case and all complications were recorded in accordance with SIR guidelines. Data was then statistically analyzed using Chi-Squared techniques to compare complication rates between the two patient groups. Results: In the genetic analysis group, a mean of 5.1 core samples (range 1-10 samples) were obtained. In the conventional biopsy group, a mean of 2.9 core samples (range 1-6 samples) were obtained. The pneumothorax rate was 37.6% in the conventional biopsy group (65/173 patients) and 30.4% in the genetic analysis group (7/23 patients), p=0.505. The rate of chest tube placement was 16.8% in the conventional biopsy group (29/173 patients) and 8.7% in the genetic analysis group (2/23 patients), p=0.319. Conclusion: No statistically significant difference is found in pneumothorax rate or need for chest tube placement between patients undergoing standard diagnostic lung biopsy and those requiring increased core samples for molecular marker analysis. [Copyright &y& Elsevier]

Purpose: Barbed suture is a self-anchoring suture that allows for quicker, more efficient wound closure by obviating the need for knot tying. The purpose of this study is to investigate the feasibility of barbed suture closure of implanted chest ports. Materials and Methods: An IRB approved retrospective study at a single academic institution was performed on all chest ports placed in the section of interventional radiology between September 2011 and May 2013. Patient demographic information and suture material for incision closure (barbed versus non-barbed) were recorded. The electronic medical record was queried for instances of port removal secondary to wound dehiscence or infection. Results: A total of 923 chest ports were placed. 555 (60%) ports were closed with non-barbed suture compared to 368 (40%) with barbed suture. The technical success rate in both groups was 100% with no cases of immediate complication. On follow up, a statistically significant difference was seen in the rate of wound dehiscence in the non-barbed group (n = 8) versus the barbed group (n= 0) [p = 0.021]. Additionally, a significant difference was seen in the rate of infection requiring port removal in the non-barbed group (49/555 = 8.9%) compared to the barbed group (17/368 = 4.6%) [p = 0.015]. These relationships held true when controlling for age, gender, and side of port placement among the two groups. Conclusion: Barbed suture is an effective technique for incision closure in implantable chest ports with lower rates of dehiscence and infection when compared to traditional non-barbed suture. [Copyright &y& Elsevier]

Purpose: To determine the long-term results of patients undergoing transcatheter coil embolization for the treatment of acute colonic hemorrhage. Materials and Methods: An IRB approved retrospective study was conducted on all consecutive patients undergoing angiography for the evaluation of suspected colonic bleeding between January 2002 and December 2012. Patient data was collected by reviewing the electronic medical chart and procedure data from PACS. Baseline, procedural, and outcome parameters were recorded following Society of Interventional Radiology guidelines. Follow up was performed on patients up through one year from date of procedure, with minimum 180 day follow up on all cases. Results: A total of 87 mesenteric angiograms were performed on 79 patients for acute colonic hemorrhage. In this group, one or multiple sites of bleeding were identified in 40 cases. Coil embolization was performed in 85% (34/40), with the remainder of cases unsuitable for intervention due to diffuse multifocal bleeding or inability to perform superselective catheterization due to vasospasm or severe atherosclerosis. Technical success was achieved in 94% (32/34), with failure defined as persistent active bleeding despite embolization. One major complication occurred: ischemia requiring bowel resection. Four patients had low grade recurrent bleeding within one year which was treated by surgical resection. Two of these patients had malignancy, one had widespread diverticulosis, and the other had multifactorial bleeding. No cases of ischemic stricture occurred. All-cause mortality of treated patients at one year was 31% (10/32). Conclusion: Transcatheter coil embolization is a durable treatment option in the setting of acute colonic hemorrhage. A modest level of re-bleeding was seen in patients within one-year that necessitated surgical resection; in the vast majority of patients, embolization proved to be definitive therapy. [Copyright &y& Elsevier]

High-flow arteriovenous malformations (AVMs) are among the rarest and most recalcitrant lesions in medicine. Patients with these anomalies are best managed longitudinally in tertiary referral centers by dedicated multidisciplinary teams that include surgeons, dermatologists, hematologists, geneticists, and interventional radiologists. A significant percentage of these lesions cannot be cured per se and intervention can worsen symptoms or preclude effective future embolization. Existing classification systems help guide treatment, but in nearly all cases, therapy must be individualized based on patient, symptoms, and lesion angioarchitecture. For various reasons, referral to tertiary centers may be impossible for some patients. The purpose of this article is to provide an approach to the evaluation and treatment of these abnormalities., Competing Interests: Conflict of Interest Consulting for Okami Medical, Cook Medical, Balt, and Cannon., (Thieme. All rights reserved.)

Background: Obsidio conformable embolic (OCE, Boston Scientific, MA) is a novel, radiopaque and conformable embolic. The purpose of this report is to describe its use for treatment of acute intra-abdominal hemorrhages., Methods and Results: Three patients presented with acute hemorrhage and were treated with OCE, including post-paracentesis hemorrhage, penetrating trauma to the liver, and blunt trauma in the spleen. All cases were performed under moderate sedation, with hemostasis achieved by end of procedure using less than 1 vial of OCE (0.2-0.4 ml). No severe adverse events occurred. None required repeated treatment., Short Conclusion: OCE is a safe and effective embolic agent for treatment of intra-abdominal or visceral hemorrhage. Future studies with larger sample sizes and longer follow-up are warranted., (© 2024. The Author(s).)

Purpose: To determine effectiveness of radiofrequency ablation for treatment of intrahepatic cholangiocarcinoma (iCCA) using a population-based database., Materials and Methods: Data was extracted from Surveillance, Epidemiology, and End Results database from 2000 to 2020 to include 194 patients who underwent ablation for iCCA. Patient demographics, overall survival (OS), and cancer-specific survival (CSS) were retrieved. Factors associated with survival were evaluated. Comparison between ablation and surgical resection (n=2653) or external beam radiotherapy (n=1068) were performed., Results: In the ablation group, atients diagnosed and treated after 2010 demonstrated improved OS than the 2000-2009 subgroup (mOS 32 versus 21 months, HR: 0.50 [95%CI: 0.33-0.75], p=0.001). Additional factors associated with OS included tumor size (≤3cm versus >3cm, p=0.049) and tumor stage (p<0.001). For patients diagnosed after 2010, the 1-, 3-, and 5-year OS were 82.8% (95%CI: 74.8-88.4%), 43.5% (95%CI: 33.5-53.1%), and 23.7% (95%CI: 15.3-33.5%), respectively. Patients with local disease (1-year OS: 87.8% [95%CI: 78.6-93.3%]) demonstrated improved OS than regional (1-year OS: 81.3% [95%CI: 52.5-93.5%]) and distant disease (50.2% [95%CI: 34.0-78.8%], p<0.001). For tumors ≤3cm, ablation and surgical resection offered comparable survival benefits (p=0.561), although both were better than radiotherapy (p<0.0001)., Conclusion: Survival of iCCA patients who underwent thermal ablation has improved over the last 10 years. For tumors ≤3cm, ablation could be as effective as resection with careful candidate selection, and may be considered as front line compared to radiotherapy in certain patient populations. Patient selection based on tumor size and disease stage could improve survival outcomes., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: To evaluate effectiveness of pulmonary arteriovenous malformation (PAVM) embolization using dual-energy computed tomography (CT) and spectral curve analysis by characterizing contrast enhancement and vascular perfusion as a surrogate of the degree of vascular occlusion after embolotherapy., Materials and Methods: Nine consecutive adult patients underwent embolization for 21 PAVMs (size range, 0.4-2.0 cm; 15/21 simple angioarchitecture) and subsequent postembolization chest dual-energy CT angiography. Twelve PAVMs were treated with vascular plugs with or without coils, whereas 9 PAVMs were treated with coils alone. Virtual spectral curves were generated using dual-energy image postprocessing in order to measure embolization effectiveness., Results: Complete occlusion of target PAVM was achieved in all cases on digital subtraction angiography (DSA) at the end of the embolization procedure. With a median follow-up of 12.7 months, the vascular plug group demonstrated significantly less vascular opacification compared with the coils-only group, as measured by opacification between upstream feeding artery and different downstream vasculature locations (Δslope1: median 79.1 vs 28.6; P = .003; Δslope2: 76.4 vs 28.6; P = .0197; Δslope3: 78.9 vs 28.6; P = .004). Persistence occurred in 3 PAVMs based on size criteria, which demonstrated higher vascular opacification by dual-energy CT (Δslope1: 72 vs 28.6; P = .253; Δslope2: 65.1 vs 32.7; P = .326; Δslope3: 72.9 vs 53.5; P = .733), although statistical significance was not reached., Conclusions: Similar to emerging literature, dual-energy CT showed improved occlusion in PAVMs treated with vascular plugs compared with those treated with coils alone., (Copyright © 2024 SIR. Published by Elsevier Inc. All rights reserved.)

Background: Thrombosis of the vascular access in patients with end-stage renal disease requiring hemodialysis are common and require timely interventional procedures to restore patency. The aim of the current study was to identify factors having a significant effect on patency rates after access thrombosis. Our hypothesis was the length of time between the initial clotting of the access and the subsequent percutaneous declotting impacts the patency rates of the vascular access., Methods: In this retrospective cohort study, patients with a clotted arteriovenous access between Jan 1, 2011, and Jan 1, 2016, were included. Demographics, access history, and associated details of the access procedure were reviewed from the electronic medical record. Statistical analysis was done using t -test and chi-square or fisher exact tests to compare arteriovenous fistulae (AVF) and arteriovenous grafts (AVG). Primary patency, defined as the time from index procedure to endpoint, was analyzed using the Kaplan-Meier method and log rank test., Results: There were 883 percutaneous declotting procedures reviewed. About 351 procedures were performed in patients with an AVF and 532 with an AVG. The mean time from thrombosis to declotting was 1.71 ± 2.29 days. The overall median primary patency for both AVF and AVG was 43 days with no difference in patency between patients with AVF (39 days) versus AVG (42 days; p  = 0.385). The time period from access thrombosis to declotting did not affect patency rates for either AVG or AVF ( p  = 0.385). On multivariable analysis, prior intervention (HR: 1.32, 95% CI: 1.14-1.53, p  < 0.001) and cardiovascular disease (HR: 1.19, 95% CI: 1.03-1.37, p  = 0.016) were independently associated with access patency., Conclusions: Time from thrombosis to declotting did not affect patency rates however once there was a thrombotic event, recurrent thrombosis requiring intervention was common with patency significantly decreased. Future prospective studies to validate our results and study pathogenic mechanisms of recurrent thrombosis are warranted., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Transarterial embolization (TAE) for acute lower gastrointestinal bleeding (LGIB) can be technically challenging due to the compromise between achieving haemostasis and causing tissue ischaemia. The goal of the present study is to determine its technical success, rebleeding, and post-embolization ischaemia rates through meta-analysis of published literature in the last twenty years., Methods: PubMed, Embase, and Cochrane Library databases were queried. Technical success, rebleeding, and ischaemia rates were extracted. Baseline characteristics such as author, publication year, region, study design, embolization material, percentage of superselective embolization were retrieved. Subgroup analysis was performed based on publication time and embolization agent., Results: A total of 66 studies including 2121 patients who underwent embolization for acute LGIB were included. Endoscopic management was attempted in 34.5%. The pooled overall technical success, rebleeding, post-embolization ischaemia rates were 97.0%, 20.7%, and 7.5%, respectively. Studies published after 2010 showed higher technical success rates (97.8% vs 95.2%), lower rebleeding rates (18.6% vs 23.4%), and lower ischaemia rates (7.3% vs 9.7%). Compared to microcoils, NBCA was associated with a lower rebleeding rate (9.3% vs 20.8%) at the expense of a higher post-embolization ischaemia rate (9.7% vs 4.0%). Coagulopathy (P = .034), inotropic use (P = .040), and malignancy (P = .002) were predictors of post-embolization rebleeding. Haemorrhagic shock (P < .001), inotropic use (P = .026), malignancy (P < .001), coagulopathy (P = .002), blood transfusion (P < .001), and enteritis (P = .023) were predictors of mortality. Empiric embolization achieved a similarly durable haemostasis rate compared to targeted embolization (23.6% vs 21.1%) but a higher risk of post-embolization ischaemia (14.3% vs 4.7%)., Conclusion: For LGIB, TAE has a favourable technical success rate and low risk of post-embolization ischaemia. Its safety and efficacy profile has increased over the last decade. Compared to microcoils, NBCA seemed to offer a more durable haemostasis rate at the expense of higher ischaemia risk. Due to the heterogeneity of currently available evidence, future prospective and comparative studies are warranted., Advances in Knowledge: (1) Acute LGIB embolization demonstrate a high technical success rate with acceptable rate of rebleeding and symptomatic ischaemia rates. Most ischaemic stigmata discovered during routine post-embolization colonoscopy were minor. (2) Although NBCA seemed to offer a more durable haemostasis rate, it was also associated with a higher risk of ischaemia compared to microcoils. (3) Coagulopathy, malignant aetiology, and inotropic use were predictors of rebleeding and mortality. (4) Routine post-embolization endoscopy to assess for ischaemia is not indicated., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

We report a rare case of hereditary hemorrhagic telangiectasia (HHT) in a 4-month-old female infant with findings of child abuse. She presented with poor feeding, vomiting, and irritability after a short fall from the bed. Initial evaluation found subdural hematomas, persistent hypoxia, failure to thrive, a frenulum tear, facial lacerations, and bruising. The patient was admitted, and an extensive workup led to the diagnosis of brain and pulmonary arteriovenous malformations and finally the diagnosis of HHT. The subdural hematomas, cutaneous injuries, and oral injury were highly suspicious for child abuse and were reported to Child Protective Services and law enforcement for investigation simultaneous to the medical work-up. Her hospital course was complicated by progressive hypoxemia with radiographic evidence of several large pulmonary arteriovenous malformations, for which she underwent successful embolization. Her head injury was indeterminate for physical abuse in the setting of a medical condition predisposing to intracranial hemorrhage. A few weeks later, she was readmitted with repeat abusive injuries in the form of femur fractures. This case demonstrates the unique diagnostic dilemma when 2 diagnoses are occurring simultaneously-HHT and child abuse-and showcases the importance of a detailed family history, genetic testing, strong multidisciplinary collaboration with a holistic approach and medically informed Child Protective Services systems to ensure accurate diagnoses and safe disposition., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s).)

This brief report describes safety, technical feasibility, and early treatment effectiveness of the low-profile braided occluder (LOBO; Okami Medical, San Diego, Caliornia) for embolization of 9 pulmonary arteriovenous malformations (PAVMs) in 4 patients (3 female and 1 male; age range: 33 to 63 years; 3 patients showed positive results for hereditary hemorrhagic telangiectasia genes). A total of 10 occluders were deployed in 10 vessels (median treated vessel diameters, 3 and 4 mm for LOBO-3 and LOBO-5 groups, respectively). All devices were successfully deployed into the feeder pulmonary arteries, achieving complete cessation of flow. There were no severe adverse events or device migrations. Available short-term follow-up computed tomography (6 PAVMs: median, 7 months; range, 1.5-7 months) demonstrated complete occlusion without persistence or recanalization. The early experience of embolization of PAVMs using a low-profile braided occluder showed it to be safe and effective. Further studies with larger cohorts and longer follow-up periods are warranted., (Copyright © 2023 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the effectiveness of trans-arterial vascular interventions in treatment of civilian gunshot wounds (GSW)., Materials and Methods: A retrospective review was performed at a level-1 trauma center to include 46 consecutive adults admitted due to GSW related hemorrhage and treated with endovascular interventions from July 2018 to July 2022. Patient demographics and procedural metrics were retrieved. Primary outcomes of interest include technical success and in-hospital mortality. Factors of mortality were assessed using a logistic regression model., Results: Twenty-one patients were brought to the endovascular suite directly (endovascular group) from the trauma bay and 25 patients after treatment in the operating room (OR group). The OR group had higher hemodynamic instability (48.0% vs 19.0%, p = 0.040), lower hemoglobin (12.9 vs 10.1, p = 0.001) and platelet counts (235.2 vs 155.1, p = 0.003), and worse Acute Physiology and Chronic Health Evaluation (APACHE) score (4.1 vs 10.2, p < 0.0001) at the time of initial presentation. Technical success was achieved in all 40 cases in which targeted embolization was attempted (100%). Empiric embolization was performed in 6/46 (13.0%) patients based on computed tomographic angiogram (CTA) and operative findings. Stent-grafts were placed in 3 patients for subclavian artery injuries. Availability of pre-intervention CTA was associated with shorter fluoroscopy time (19.8 ± 12.1 vs 30.7 ± 18.6 min, p = 0.030). A total of 41 patients were discharged in stable condition (89.1%). Hollow organ injury was associated with mortality (p = 0.039)., Conclusion: Endovascular embolization and stenting were effective in managing hemorrhage due to GSW in a carefully selected population. Hollow organ injury was a statistically significant predictor of mortality. Pre-intervention CTA enabled targeted, shorter and equally effective procedures., (© 2023. Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and Springer International Publishing AG.)

Competing Interests: Conflicts of Interest B.F.: Consultant, Okami Medical. R.J.L: Consultant, BD, Boston Scientific, Varian.