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To evaluate the safety and efficacy of arterial embolization to relieve shoulder pain secondary to adhesive capsulitis (AC).In total, 20 patients (18 females, 2 males; mean age, 51 years) with AC resistant to30 days of conservative treatment were enrolled in a multicenter prospective study. Adhesive capsulitis embolization was performed with 75-μm or 200-μm spherical particles. Subjects were assessed before and after the procedure with magnetic resonance imaging, visual analog scale (VAS; 0-100 mm) scores, Single Assessment Numeric Evaluation (SANE; 0-100) scores, and American Shoulder and Elbow Surgeons (ASES; 0-100) scores. Adverse events were recorded at all follow-up time points.Hypervascularity was identified and embolization was technically successful in all patients, with 83 arteries embolized in 20 patients. Baseline VAS, SANE, and ASES scores before the procedure were 89.2 mm, 27.2, and 30.9, respectively. The 1-month (n = 19), 3-month (n = 18), and 6-month (n = 12) follow-ups demonstrated significant improvements. At the 1-month follow-up, VAS score decreased by 31.8 (P = 1.2E-11), SANE score increased by 22.1 (P = 1.8E-8), and ASES score increased by 14.2 (P = 4.3E-5). At the 6-month follow-up, VAS score decreased by 62.1 (P = 7.0E-11), SANE score increased by 55.4 (P = 4.1E-10), and ASES score increased by 44.5 (P = 1.8E-6). Due to the coronavirus pandemic, the study ended early; 6 patients did not complete the 6-month follow-up. No major adverse events were noted.Interim findings suggest that arterial embolization is safe and effective for patients with AC refractory to conservative treatment.

Interventional radiology procedures are being increasingly used to mitigate chronic pain. In addition to established therapies such as thermal bone lesion ablation, kyphoplasty, and chemical neurolysis, ongoing research has shown promising results for the use of embolization in treatment of osteoarthritic knee pain and chronic pain secondary to adhesive shoulder capsulitis. This review will highlight some of the most common interventional radiology pain procedures, as well as provide insight into future pain-relieving embolization.

Adhesive capsulitis (AC) is an inflammatory process characterized by limited shoulder mobility and pain. The prevalence of AC is as high as 5% in the general population but increases up to 20% in patients with diabetes. The current management algorithm for AC consists of physical therapy followed by pharmacological treatment. Surgical options are reserved for those with refractory pain. Adhesive capsulitis embolization (ACE) is a new minimally invasive procedure that involves particle embolization of the inflammatory vessels linked to chronic shoulder pain. Early studies show promising results with significant improvement in shoulder pain and mobility. The present case describes a 40-year-old woman who underwent ACE for refractory shoulder pain and discusses the postoperative management of ACE.

Purpose To review and indirectly compare the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Materials and Methods A literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostate artery embolization (PAE). Data on the following variables were included: international Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL), and post-void residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect. Results No significant difference in outcomes between therapies were noted for IPSS at the 3-, 6-, and 12-month follow-ups. Although outcomes for rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation vs PAE vs Rezum. TURP PVR was significantly better than Urolift at 3-, 6-, and 12 months. No significant differences in minor or major AEs were noted. Conclusion Although significant differences in outcomes were limited, aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while aquablation has limited high quality data and has been associated with bleeding-related complications.

To determine the role of prostate volume as a predictor of outcome after prostatic artery embolization (PAE).From January 2012 to September 2014, 78 consecutive patients undergoing PAE were evaluated at baseline and 1, 3, and 6 months. Analysis was performed comparing prostate volume groups (group 1,50 cm3; group 2, 50-80 cm(3); group 3,80 cm3) at baseline and follow-up to assess for differences in outcomes of American Urological Association (AUA) symptom index, quality of life (QOL)-related symptoms, and International Index of Erectile Function (IIEF).Mean baseline prostate volumes were 37.5 cm(3) in group 1 (n = 16), 65.7 cm3 in group 2 (n = 26), and 139.4 cm3 in group 3 (n = 36). There were no significant differences in baseline age, AUA symptom index, QOL, or IIEF between groups. Bilateral embolization was successful in 75 of 78 patients (96%). Two patients underwent unilateral embolization, and treatment failed in one patient as a result of bilateral atherosclerotic occlusion. A significant reduction in AUA symptom index was achieved within groups from baseline to 1, 3, and 6 months (n = 77): in group 1, from 27.2 to 14.0, 12.9, and 15.9, respectively (P = .002); in group 2, from 25.6 to 17.1, 16.3, and 13.5, respectively (P.0001); and in group 3, from 26.5 to 15.2, 12.5, and 13.6, respectively (P.0001). There was also a significant improvement in QOL. Comparative analysis demonstrated no statistically significant differences in AUA symptom index, QOL, or IIEF between groups. Two minor complications occurred: groin hematoma and a urinary tract infection.PAE offers similar clinical benefits to patients with differing gland sizes and may offer a reasonable alternative for poor candidates for urologic surgery.

Recurrent hemarthrosis is an uncommon but troublesome complication following knee arthroplasty. This study reports the results for 13 patients with spontaneous recurrent hemarthrosis after knee arthroplasty treated with arterial embolization. The average interval between arthroplasty and embolization was 47 months (range, 2-103 months), and the average time from onset of hemarthrosis to embolization was 4.1 months (range, 1-11 months). Geniculate arterial embolization lead to resolution of hemarthrosis in 12 of 13 patients (92.3%). The one clinical failure likely represented a case of misdiagnosed periprosthetic joint infection. Two patients experienced transient cutaneous ischemia related to distal particulate embolization that resolved spontaneously. Selective geniculate arterial embolization is an effective and safe treatment modality for recurrent hemarthrosis after knee arthroplasty.

Purpose To evaluate the utility of cone-beam computed tomography (CT) in patients undergoing prostatic artery (PA) embolization (PAE) for benign prostatic hyperplasia. Materials and Methods From January 2012 to January 2013, 15 patients (age range, 59–81 y; mean, 68 y) with moderate- or severe-grade lower urinary tract symptoms, in whom medical management had failed were enrolled in a prospective United States trial to evaluate PAE. During pelvic angiography, 15 cone-beam CT acquisitions were performed in 11 patients, and digital subtraction angiography was performed in all patients. Cone-beam CT images were reviewed to assess for sites of potential nontarget embolization that impacted therapy, a pattern of enhancement on cone-beam CT suggesting additional PAs, confirmation of prostatic parenchymal perfusion before embolization, and contralateral prostatic parenchymal enhancement. Results Cone-beam CT was successful in 14 of 15 acquisitions, and PAE was successful in 14 of 15 patients (92%). Cone-beam CT provided information that impacted treatment in five of 11 patients (46%) by allowing for identification of sites of potential nontarget embolization. Duplicated prostatic arterial supply and contralateral perfusion were each identified in 21% of patients (three of 11). Prostatic perfusion was confirmed before embolization in 50% of acquisitions (seven of 14). Conclusions Cone-beam CT is a useful technique that can potentially mitigate the risk of nontarget embolization. During treatment, it can allow for the interventionalist to identify duplicated prostatic arterial supply or contralateral perfusion, which may be useful when evaluating a treatment failure.

Purpose Traditional urologic surgery of small-volume benign prostatic hyperplasia (BPH) is associated with high failure rates and complications such as bladder neck strictures and contractures. While prostate artery embolization (PAE) is postulated to be effective secondary to gland size reduction, we hypothesize that it may be equally effective in patients with small volume glands. We present our experience of PAE in prostate sizes Material and Methods An Institutional Review Board approved a retrospective study of 78 consecutive PAE patients from January 2011 to July 2014. Patients were evaluated at baseline, 1, 3, and 6 months with the American Urological Association (AUA-SI) symptom index including quality of life-related symptoms (QoL), International Index of Erectile Function (IIEF), and prostate imaging (magnetic resonance imaging, ultrasound, or computed tomography at baseline). Analysis was performed for each stratified group (Group 1, prostate volume 50 cc) individually from baseline to 1, 3, and 6 months and between groups at each follow-up to assess for differences in outcome. Results There were no significant differences in baseline age, AUA score, QoL, or IIEF between groups (mean age 65.2 years, 26.4 AUA, 4.9 Qol, 14 IIEF; n = 78). Baseline volumes were: group 1 (37.5 cc, 25.9 to 48.0 cc, n = 16) and group 2 (108.5 cc, 52.0 to 274.0 cc, n = 62 }. Technical success was achieved in 16/16 patients in Group 1 and 59/62 in Group 2, with 2 unilateral embolizations and 1 unsuccessful secondary to bilateral atherosclerotic occlusion in the latter group. A statistically significant reduction in AUA was achieved in both groups from baseline to 1, 3 and 6 months (n = 77): Group 1: Baseline 27.2 to 12.7, 12.0, and 11.2 at 1, 3, and 6m (p Conclusions PAE appears to offer similar positive clinical benefits to 6 months in patients with small-volume BPH. This may offer crucial benefit to those patients with limited surgical options. Future study aimed at evaluating recurrence rates is suggested.

Introduction: Nocturia is a major problem in men with lower urinary tract symptoms(LUTS) and Benign Prostatic Hyperplasia (BPH). Transurethral resection of the prostate (TURP) and photoselective vaporization (PVP) have been shown to reduce nocturnal frequency in 32.2% of patients by 0.8 to 1.0 episodes per night, though they carry the risk of operative morbidity. We report on the efficacy of prostatic artery embolization (PAE) in the reduction of nocturia. Materials & Methods: IRB-approved retrospective study was performed of sixty-eight PAE patients performed in two U.S. centers (Site 1 n=40, Site 2 n=28). American Urological Association symptom index (AUA-SI), quality of life-related symptoms (QoL), nocturnal frequency were evaluated at baseline and at one and three-months. A paired t-test was performed to assess significance. Results: Baseline demographics demonstrated mean age 64.5 years, AUA-SI 23.9, QoL 4.8, PV 80.6 cc, and Nocturnal Frequency 3.3 episodes. 54.4% (25/46) of patients reported improvement in nocturnal frequency at 1 month and 73.7 % (28/38) at 3 months. Absolute reduction of 0.82 and 1.56 episodes per night were reported at 1 and 3 months (p

Prostatic arterial embolization (PAE) has emerged as a minimally invasive alternative to TURP; however, there are limited cost comparisons reported. The purpose of this study was to compare in-hospital direct costs of elective PAE and TURP in a hospital setting. Institutional Review Board-approved retrospective review was performed on patients undergoing PAE and TURP from January to December 2014. Inclusion criteria included male patients greater than 40 years of age who presented for ambulatory TURP or PAE with no history of prior surgical intervention for BPH. Direct costs were categorized into the following categories: nursing and operating room or interventional room staffing, operating room or interventional supply costs, anesthesia supplies, anesthesia staffing, hospital room cost, radiology, and laboratory costs. Additionally, length of stay was evaluated for both groups. The mean patient age for the TURP (n = 86) and PAE (n = 70) cohorts was 71.3 and 64.4 years, respectively (p

at 1 month in 26/39 (67%), unchanged in 6/39 (15%), and decreased in 7/39 (18%) of patients. 30 patients had imaging follow up with 60% demonstrating local tumor control, and select cases showing retraction of posterior tumor with epidural extension. Most RFAs were followed by vertebral augmentation for lesions with or at risk of pathological fractures. Conclusion: Targeted RFA is a safe and effective method of treating spinal metastases resistant to RT with significantly improved pain and functional scores.

Purpose: Percutaneous ablation of lung tumors is a minimally invasive therapy for patients with primary or metastatic cancer who are not surgical candidates or in whom standard therapy fails. We present our experience with percutaneous MWA of lung tumors. Materials and Methods: 14 consecutive patients (3 male, 11 female), aged 64-89, underwent 17 treatments of 17 target lesions. 9/17 tumors were primary non-small cell lung carcinomas and 8/17 were metastatic (Colon n1⁄42, Hepatobiliary n1⁄41, Neuroendocrine n1⁄41, Head and Neck n1⁄44). Clinical evaluation was performed at baseline, 2 weeks, 30 days and 6 months. Response was assessed using Modified Response Evaluation Criteria in Solid Tumors (n1⁄413) at 6 months and classified as: Complete Response (CR), Partial Response (PR), or Progressive Disease (PD). Complications were reported according to Society of Interventional Radiology Grading System [1,2]. Results: Baseline Eastern Cooperative Oncology Group performance status average was 0.9 (range 0-3). Mean tumor size for 2.4 cm (N1⁄417, 1.2 cm-5.8 cm); mean tumor size was 2.6 cm (Primary N1⁄49, 1.4 cm-4.5 cm) and 2.1cm (Metastatic n1⁄48, 1.2 cm-5.8 cm). 16/17 treatments were technically successful with one unsuccessful case secondary to inability to place the probe safely through the tumor. 30 day, 6 month and 1 year survival was: 100% (n1⁄414), 100% (n1⁄411) and 100%(n1⁄47). Response rates for primary and metastatic tumors were as follows: (Primary, n1⁄46) CR 83%, PR 17%, PD 0 %, (Metastatic, n1⁄47) CR 100%, PR 0.0%, PD 0%. One case of locally progressive disease was initially treated with palliative intent. Three major and 2 minor complications: pneumothorax requiring chest tube placement (3/17), pneumothorax without chest tube (1/17), self-resolved hemoptysis (1/17). Conclusion: Percutaneous microwave ablation is a feasible and potentially safe technique for lung tumor ablation with promising response rates.