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Duodenal varices are ectopic varices that can cause severe and life-threatening gastrointestinal bleeding. Diagnosis and treatment of ectopic varices is challenging, because endoscopy is often unproductive in detecting and treating ectopic varices. Interventional radiology appears as an alternative in this setting, thanks to its important role in treating the bleeding caused by ectopic varices and in preventing rebleedings. We present an interesting case of bleeding ectopic varices in a male 62-years-old cirrhotic patient (Child-Pugh B8). The patient presented with hemorrhagic shock caused by massive melena. CT angiography showed intraluminal blood and identified the source of bleeding as an ectopic varicose vein draining into the superior mesenteric vein. Interventional radiology approach was the only applicable one to reach and effectively treat the source and cause of bleeding by TIPS placement and embolization of the collateral feeding at the same session.

Background: CVCs are defined ‘complex’ when they are inserted through non-conventional accesses or positioned in non-usual sites or substituted by IR endovascular procedures. We report our experience in using diagnostic and interventional radiology techniques for complex CVC insertion and management; we recommend some precautions and techniques that could lead to long-term availability of central venous access and to avoid non-conventional sites CVC insertion. Methods: We retrospectively evaluated 617 patients, between January 2010 and December 2019, (mean age 71 ± 13; male 448/617), treated in our department for insertion of tunnelled CVC for haemodialysis. Results: Among 617 patients, 241 cases (39%) are considered ‘complex’ because they required either a PTA with or without stenting to restore/maintain venous access or had an unusual positioning site or required unconventional access. A direct correlation between CT angiography and PTA ( r = 0.95; p-value Conclusions: Precise pre-operative planning of treatment in a multidisciplinary setting and diagnostic and interventional radiology procedures knowledge allows reducing complex catheterisms in haemodialysis patient.

Among Uterine Artery Embolization (UAE) complications, vaginal discharge is considered very frequent, especially for submucosal fibroids. Until now, it was reported as clear odorless viscous material. To our knowledge, we describe the first report of intrauterine microsphere migration after UAE. A 45-year-old-woman was admitted to our hospital complaining metromenorrhagia, menstrual cramping, pelvic pain and dyspareunia. After a preprocedural Magnetic Resonance Imaging (MRI) study, she underwent a superselective transradial UAE using 500-700 µm and 700-900 µm microspheres with a good morphological results. At 2-month follow-up, she complained viscous vaginal discharge with "strange pink stiff sphere of about 2 mm in diameter". A post-procedural-MRI showed fibroid migration towards the uterine cavity, a frequent occurrence especially for submucosal fibroids. The microspheres transvascular migration outside the vessel wall was already reported in a study performed in sheep. Our hypothesis is that the phenomenon of transvascular migration along with the fibroid migration towards the uterine cavity after UAE, may have led the migration of the microspheres directly into the vaginal cavity causing chronic vaginal discharge with pink stiff sphere. Vaginal discharge mixed with "sphere of particles" should be included among the UAE late complication especially for intramural and/or submucosal fibroids with distance to the endometrium less than 2.4 mm at pre-procedural MRI.

To investigate the impact of the different access for percutaneous transhepatic biliary drainage (PTBD) in terms of “Quality of Life” (QoL) in the management of malignant obstructive jaundice. In this IRB-approved study, 64 consecutive patients with malignant obstructive jaundice were prospectively randomized to the right (group A) or left access (group B) for PTBD between February 2017 and December 2018. In order to demonstrate differences in terms of QoL between these groups, patients were asked to complete the “EORTC QLQ-BIL21” questionnaire the week after the treatment. Continuous variables were summarized by mean ± SD and compared using a Mann–Whitney U test. Percutaneous transhepatic biliary drainages were performed through right access in 31 cases and 33 cases through left access. Technical success was achieved in all cases (100%). During 1 week’s follow-up, there was a significant difference between group A and B in terms of pain (p

Varicocele is a relatively complex pathology that affects the pampiniform plexus of veins in the spermatic cord. Modern treatment involves both urological/surgical and interventional procedures. Our objective is to compare outcomes of conventional laparoscopic ligation (LL) and occluding balloon embolization (OBE) a percutaneous interventional procedure. We treated retrospectively a total of 98 patients, divided in two cohorts; arm A with 48 and arm B with 50 patients. Arm A patients underwent LL, while arm B ones were treated in interventional radiology suite, via OBE method. No comorbidities were reported, especially scrotal ones. Hence, all patients have been asked to respect 3 and 6 months’ follow-up, clinical examination and ultrasonography were performed. Age range of the entire sample: 15–45 years old, with average of 28 years. The study involved two European centers. We performed a comparative analysis (Fisher’s test) of intra-operative time, hospitalization and patient’s postoperative recovery time. Outcomes have been in line with the recent literature ones, allowing the occluding balloon embolization a small advantage for quicker operative average time, hospitalization needed and full recovery to normal activities for the patient. Main limitation was the unfeasibility of cost-effectiveness analysis due to national differences, limited sample and lack of complete semen analysis pre- and postoperative. Both OBE and LL are safe and effective procedures in the treatment of varicocele, conceding OBE a slight advantage in terms of hospital stay and full recovery to normal activity of patients.

Transradial artery approach as primary access for transcatheter diagnosis and intervention is associated with lower risk of bleeding and major vascular complications, improved patient comfort and shorter time to hemostasis and ambulation than femoral one. Patient’s adequate hand collateral perfusion, assessed by the Barbeau test, must be depicted prior to transradial artery approach in order to assess any absolute contraindication (D waveform). We describe the distal transradial artery approach, recently proposed for coronary interventions, used in emergency to embolize an intestinal bleeding in an 84-year-old woman and a left pectoralis major muscle bleeding in an 83-year-old woman, both with high risk of bleeding for femoral approach and contraindication for transradial artery approach (Barbeau D waveform).

Introduction: Varicocele is a relatively complex pathology of the scrotum veins', known to be one of the easiest to treat. Modern treatment involves both surgical (open, laparoscopic and microsurgery) and interventional approach (either with coils and/or sclerosant injection). Our aim is to demonstrate the feasibility and the reliability of endovenous laser ablation (EVLA) of the spermatic vein for the treatment of varicocele. Materials and methods: We consecutively and prospectively treated 11 patients (age range 24â45 years old, mean 31y) with left varicocele, phlebografically classified as Bahren type I and with indication for percutaneous treatment. Clinical success was evaluated by color doppler ultrasound (CDUS) one week, one months and three months after the procedures. We also evaluated the pain feeling for 48Â h after the procedure on the basis of the visual analogue score (VAS) obtained through telephonic interview. Results: Technical success was achieved in all cases. In all cases varicocele disappeared at CDUS at 1 and three months with reflux abolition. Two cases of small vein laceration were noted without sequelae, no other complication has been described. All patients reported improvements either regarding symptoms and/or spermiographic parameters. Conclusions: In our experience, EVLA of spermatic vein is a feasible and safe treatment in patients with Bahren type I varicocele. The key advantage of this technique is the adoption of a standardized protocol, which remains one of the main problems in gaining scientific evidence in case of coil or sclerosant embolisation (type and number of coils, amount of sclerosant agent etc). Keywords: Varicocele, Laser, Therapy, Treatment, Evla, Endovenous, Ablation, Minimal invasive

The aim of our study is to report the results of two types (type A, type B) paclitaxel drug-coated balloon compared with standard percutaneous transluminal angioplasty in the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic hemodialysis arteriovenous fistulas. Two groups of 26 and 44 patients treated with two different drug-coated balloon are compared with a control group of 86 treated with standard percutaneous transluminal angioplasty. A color Doppler ultrasound was performed to evaluate stenosis and for treatment planning. We assess primary patency, defined as the absence of dysfunction of the arteriovenous fistulas, patent lesion or residual stenosis < 30% and no need for further reintervention of target lesion. Primary patency and secondary patency are evaluated after 12 months with color Doppler ultrasound for the whole arteriovenous fistulas, defined as absolute (absolute primary patency, absolute secondary patency) and target lesion. Postprocedural technical and clinical success was 100%. After 12 months, absolute primary patency is 81.8% for type A, 84.1% type B, and 54.7% for standard percutaneous transluminal angioplasty; target lesion primary patency is 92% type A, 86.4% type B, and 62.8% standard percutaneous transluminal angioplasty; absolute secondary patency is 95.4% type A, 95.5% type B, and 80.7% standard percutaneous transluminal angioplasty; target lesion secondary patency is 100% type A, 97.7% type B, and 80.7% standard percutaneous transluminal angioplasty. All the patients treated with drug-coated balloon (type A + type B) have an absolute primary patency of 83.3%, a target lesion primary patency of 87.9%, an absolute secondary patency of 95.5%, and a target lesion secondary patency of 98.4%. Our study confirms that the use of drug-coated balloon, indiscriminately among different brands, improves primary patency with statistically significant difference in comparison with standard percutaneous transluminal angioplasty and decreases reintervention of target lesion in juxta-anastomotic stenoses of failing distal arteriovenous fistulas maintaining the radiocephalic fistula as long as possible.

The aim of our study is to verify VAS and patient compliance in the immediate post-procedural time, in patients undergoing UAE through radial approach versus femoral procedure. Between January and September 2017, 30 consecutive patients (age range 28–47, average 32 years) were enrolled for the study. UAE was performed by two interventional radiologists with more than 10 years of experience and more than 100 cases of UAE done. Patients were divided into two groups: transfemoral approach (group a, n = 15 patients) and transradial approach (group b, n = 15 patients). After procedure, patients were questioned about the compliance using the questionnaire at 24 h and VAS rating at 6, 12, 18 and 24 h. The average of VAS in group b was lower than in group a in each evaluation at 6 h (p

spine metastases are common concern from several primary neoplasms, modern management include percutaneous techniques such as ablation and cementoplasty. This research aims to evaluate the treatment under local anaesthesia in high-risk patients (ASA III).from January 2013 up to September 2016 we treated via percutaneous cryoablation 11 advanced oncological patients classified as ASA III, then retrospectively a review of their clinical history has been performed. Interventions were managed under local anaesthesia, injecting low doses of bupivacaine 2,5mg/ml (from10 to 30ml). Cryoprobes of 17G were introduced under CT guidance. VAS scores were evaluated pre, intra and post operative up to the 3rd month and further, statistical analyses were obtained using T student test.thirteen spinal metastases were cryoablated in 11 patients (6W, 5M; mean age of 53 years, range 52-81). Tumour location was: sacrum (n=6), lumbar spine (n=3), thoracic spine (n=2). The average VAS value during the procedure was 5,27 (standard deviation 0,90). There were statistically significant decreases in the median numeric VAS scale score at 1-week, 1-month, and 3-month time points (P.001 for all). Technical success was achieved in all cases. Among patients with neurological deficit, some clinical improvement was assessed.cryoablation with or without subsequent cement injection can be safely performed with local anaesthesia for pain relief also in patients with high ASA score with higher risk of complications, in the absence of any other suitable treatment.

Background. The aim of this study was to compare values of apparent diffusion coefficient (ADC) and diffusion (D) with renal function indexes, in a population of kidney transplant recipients who underwent magnetic resonance with diffusion-weighted imaging (DWI) of the transplanted graft. Materials and Methods. We studied 21 patients using a 1.5-Tesla magnetic resonance; DWI sequences were acquired with several b-values. Patients were divided into 3 groups by their creatinine clearance values: group A, clearance >60 mL/min; group B, clearance >30 and ≤60 mL/min; and group C, clearance ≤30 mL/min. ADCs values between groups were compared using the Mann-Whitney U test. Receiver operating characteristic (ROC) curves were created for prediction of normal renal function (group A) and renal failure (group C). Results. Comparing mean values of ADC between groups A and C, we observed a difference (P = 0.0012), with higher values in group A. Regarding mean values of D, we observed a difference between groups A and C (P = 0.022). In the comparison between contiguous groups, we observed no difference for ADC and D values. In the prediction of normal clearance values (group A), ROC curve showed an area under curve (AUC) of 0.861, with a sensitivity of 88.89% and specificity of 75% using a threshold ADC value ≥2.1 × 10- 3 mm 2 /sec. For prediction of normal clearance values (group A), ROC curve showed an AUC of 0.787, with a sensitivity of 77.8% and specificity of 83.3% using a threshold D value ≥2.3 × 10- 3 mm 2 /sec. Conclusion. Although studies with a larger number of patients are needed, DWI represents a promising tool for noninvasive assessment of renal function. An ADC ≥ 2.1 × 10 -3 mm 2 /sec and a D ≥ 2.3 × 10- 3 mm 2 /sec may be used as a threshold for predicting normal clearance.

The aim of this study was to compare the technical success between left spermatic vein (LSV) scleroembolisation achieved with the injection of sclerosant through a diagnostic catheter and through an occluding balloon (OB), in the treatment of male varicocele. From January 2012 to September 2013, we prospectively enrolled 100 patients with left varicocele and an indication for LSV scleroembolisation related to symptoms or spermiogram anomalies; patients were randomised to two groups (we wrote a list of 100 lines assigned casually with A or B and each patient was consecutively allocated to group A or B on the basis of this list). Patients in group A underwent injection of the sclerosing agent through an angiographic diagnostic catheter (free catheter technique) and patients in group B through an OB catheter (OB technique). In cases of incomplete occlusion of the LSV, the procedure was completed with coils. Total occlusion of the LSV at post-treatment phlebography during a Valsalva manoeuvre before any coil embolisation was considered a technical success. The rate of complications was also evaluated. The Fischer’s test was used for statistical analysis. We evaluated a total of 90 patients because five patients for each group were not included in the statistical analysis owing to technical problems or complications. In group A we had a technical success of 75.6 versus 93.4 % in group B, and the difference was statistically significant (P = 0.003); in particular, we had to complete the embolisation with insertion of coils in 11 cases (24.4 %) in group A, and in three cases in group B (6.6 %). In group A, LSV rupture occurred in four cases (8 %) so the procedure was completed by sclerosant injection through the OB located distally to the lesion. These patients were not considered for evaluation. In another case, a high flow shunt towards the inferior vena cava was detected, so the patient underwent OB injection to stop the flow to the shunt, and was not included for statistical evaluation. In group B, vein rupture with contrast leakage was noted in six cases (12 %); nonetheless, all the procedures were completed because the OB was positioned distally to the vessel tear, obviating any retrograde leakage of sclerosant. In group B, in five cases (10 %), we were unable to advance the OB though the LSV ostium so the procedures were completed with the diagnostic catheter and not considered for statistical evaluation. On the basis of our data, the embolisation of the LSV obtained by injecting the sclerosant through an OB rather than through a diagnostic catheter seems to be more effective in achieving total vein embolisation, as well as allowing a controlled injection of sclerosant even in cases of vein rupture.

This study was designed to demonstrate the feasibility and the reliability of microwave ablation (MWA) of epiphyseal osteoid osteomas (OO). From February to November 2012, 7 patients (4 males and 3 females; age range 16–30 years) with epiphyseal OOs were treated with MWA. The treatment was performed with 16 G antennas with a power of 20 W for 2 min. The OOs were approached by using coaxial needles inserted with hammer or with automatic drill. All patients underwent spinal anaesthesia, with posttreatment 6–8 h observation before discharging. We treated epiphyseal OOs placed away from nervous and vascular nontarget structures, located in: femoral head (n = 2), femoral lesser trochanter (n = 2), femoral neck (n = 2), and proximal tibial epiphysis (n = 1). CT was used to visualize the nidus and to insert the needle for thermal ablation and for postprocedure control. Technical success was considered the positioning of the antenna in the nidus, while the efficacy of treatment was clinically evaluated as the complete remission of pain after the procedure by using the visual analogue score (VAS). Follow-up was performed by using VAS score 1 day, 1 week, and 1, 3, and 6 months after the procedure, whereas MRI examination was performed immediately after the procedure, at 1 month, and in any case of recurrence. Complications were also recorded. All patients experienced resolution of the symptomatology (VAS = 0) in ~1 week until the last follow-up, with residual VAS

Background We compared values of apparent diffusion coefficient (ADC) with renal function indices among a population of kidney transplant recipients who underwent magnetic resonance with diffusion-weighted imaging (DWI) of their grafts. Materials and Methods Thirty-five patients with right iliac transplanted kidneys were studied using 1.5-T magnetic resonance. Diffusion echo-planar sequences with several b-values were acquired to investigate transplanted grafts. Patients were divided into 3 groups according to their creatinine clearances; Group A, clearance >60 mL/min; Group B, clearance >30 and ≤60 mL/min; and Group C, clearance ≤30 mL/min. ADC values between groups were compared using Mann-Whitney U test. Receiver operating characteristic (ROC) curves were used to predict the normal function (Group A) versus renal failure cohorts (Group C). Results Comparing mean values of ADC between Group A and Group C patients, we observed a significant difference ( P = .0003) with higher ADC values among patients with a normal creatinine clearance (>60 mL/min). Comparing Groups B and C did not show a significant difference ( P = .05); nor did Group A and Group B reveal a significant difference ( P = .38). To predict normal clearance values, the Group A ROC curve showed an area under curve (AUC) of 0.780 with a sensitivity of 92.3% and a specificity of 68.2% at a threshold ADC value of ≥2.08 × 10 −3 mm 2 /sec. In the prediction of low clearance values, the Group C ROC curve showed an AUC of 0.846 with a sensitivity of 83.3% and a specificity of 82.6% using a threshold ADC value of ≤2.07 × 10 −3 mm 2 /sec. Conclusions Updating our experience among 35 patients, DWI was confirmed to be a promising noninvasive tool to assess renal function; an ADC ≥2.08 × 10 −3 mm 2 /sec may be used as a threshold to predict a normal clearance. However, an overlap of ADC values between groups is a limit.