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The purpose of this report is to describe deployment of the Relay NBS Thoracic Stent Graft with the Plus Delivery System (Bolton Medical, Sunrise, FL) in a flexible resin arch model with a 15-mm radius curve as well as our preliminary clinical results. The Relay NBS graft with the Plus Delivery System was evaluated by way of bench testing, which was performed with stent grafts with diameters ranging from 24 to 46 mm and lengths ranging from 100 to 250 mm in flexible resin arch models with a 15-mm arch radius of curvature. The deployment sequence was analyzed. The Relay NBS graft with the Plus Delivery System was deployed in two patients, respectively, having a 6.5-cm penetrating aortic ulcer of the proximal third of the descending thoracic aorta and a DeBakey type-I aortic dissection with chronic false lumen dilatation after surgery due to an entry site at the distal thoracic aorta. Bench tests showed proper conformation and apposition of the Relay NBS graft with the Plus Delivery System in the flexible resin model. This stent graft was deployed successfully into the two patients with a correct orientation of the first stent and without early or late complications. The Relay NBS graft with the Plus Delivery System ensures an optimal conformation and apposition of the first stent in the aortic arch with a small radius of curvature. [ABSTRACT FROM AUTHOR]

The purpose of this study is to report our preliminary experience using MDCT-guided percutaneous transthoracic needle aspiration biopsy using the transscapular approach in the upper posterolateral lung nodules, an area that it is difficult or hazardous to reach with the conventional approach. Five patients underwent CT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach. A coaxial needle technique was used in all patients. Biopsy was successful in all patients. No major complications were encountered. One patient developed a minimal pneumothorax next to the lesion immediately after biopsy, which resolved spontaneously. MDCT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach is an effective and safe procedure that reduces the risk of pneumothorax in selected patients. [ABSTRACT FROM AUTHOR]

The purpose of this communication is to describe our preliminary experience with the Amplatzer Vascular Plug 4 (AVP 4) in peripheral vascular embolization. The AVP 4 was used for peripheral vascular embolization in five patients with renal pseudoaneurysm (n = 2), postsurgical peritoneal bleeding (n = 1), posttraumatic gluteal hemorrhage (n = 1), and intercostal pseudoaneurysm (n = 1). Occlusion time was recorded. Patients were followed up clinically and by imaging for 1 month after the procedure. All treated vessels or vascular abnormalities were successfully occluded within 3 min for low-flow circulation and over 8 min for high-flow circulation. At 1-month follow-up, all patients were symptom-free. All deployed devices remained in the original locations and desirable configurations. In conclusion, the AVP 4 seems to be safe and effective for occluding peripheral vessels and vascular abnormalities. Because of its compatibility with 0.038-in. catheters, it can be deployed through a diagnostic catheter following angiography without exchanging a sheath or guiding catheter. Compared with the previous generation of vascular plugs, the AVP 4 allows for faster procedure times and decreased exposure to radiation. [ABSTRACT FROM AUTHOR]

A 70-year-old woman with a history of hypertension developed acute onset of severe tightness headache accompanied by vomiting. Patient reported having right diplopia and occasional and temporary right peripheral facial paralysis for two weeks. Neurological examination revealed only a right squint. Cerebral multi-detector computed tomographic angiography (MD-CTA) and Magnetic Resonance Imaging (MRI) revealed a giant right internal carotid aneurysm (2.7 cm) at the cavenous segment (Figure 1A, 1B). No abnormalities were noted in subarachnoid spaces and white - grey matter. A selective digital subtraction angiography (DSA) of the right internal carotid artery confirmed the giant aneurysm at the cavenous segment (Figure 2A, 2B). Subsequently endovascular flow-diverting stent was deployed at the cavernous segment of the right internal carotid artery to treat over time the giant aneurysm. Her clinical course has no neurological symptoms and she was discharged after two days with established over time clinical and imaging follow-up. Giant intracranial aneurysms and vascular anomalies of the internal carotid are rare, and are defined "giant" those greater than 2.5 cm in diameter (1-4). Conservative treatment of giant intracranial aneurysms have a mortality rates of 65-100% in 2-5 years (4). Clinical presentation of internal carotid aneurysms at the petrous segment can manifest from no-symptom to headache, cranial nerve disturbs and epistaxis (1- 4). MD-CTA and MRI are the two gold standard methods for diagnosis in patients with suspected internal carotid artery and intracranial artery aneurysm (1,5). Internal carotid aneurysms at the cavenous segment are located in a surgically difficult accessible area, therefore endovascular percutaneous techniques are considered the first lines treatments (6).

Background: The self-locating peritoneal dialysis (PD) catheter, contains a tungsten tip. The effects of magnetic resonance (MR) on the catheter were evaluated, emphasizing its MR signal, artifacts, ferromagnetism, and possible heating production during the MR sequences., Methods: The catheter was studied in an ex vivo model using a 1.5T MR system and placed into a plastic box containing saline solution. Acquisitions on coronal and axial planes were obtained on fast gradient-echo T1-weighted and fast spin-echo T2-weighted. In vivo abdominal MR exams were also carried out., Results: Overall, the catheter had good visibility. In all sequences, an extensive paramagnetic blooming artifact was detected at the level of the tip tungsten ballast, with a circular artifact of 5 cm in diameter. The catheter showed no magnetic deflection, rotation, or movements during all MR sequences. After imaging, the temperature of the saline solution did not change compared to the basal measurement. Patients safely underwent abdominal MR., Conclusions: The results point to the possibility of safely performing MR in PD patients carrying the self-locating catheter. The self-locating PD catheter is stable when subjected to a 1.5T MR system. However, it creates some visual interference, preventing an accurate study of the tissues surrounding the tungsten tip., Competing Interests: The authors declare that they have no conflicts of interest to disclose., (Copyright © 2023 Maurizio Gallieni et al.)

Leriche syndrome is characterized by abdominal aorta and/or bilateral iliac occlusive disease, with a triad of clinical symptoms and signs such as claudication, erectile dysfunction, and decreased distal pulses. Diagnostic imaging is one of the key factors for diagnosis of the anatomic origin of the Leriche symptoms. We report the case of a 56-year-old man with diagnosis of abdominal aorta and bilateral iliac occlusive disease with a wide collateral vascular network., Competing Interests: The authors declare no conflict of interest related to this article., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Anastomotic aortic false aneurysm with consequent erosion of vertebral bodies is a very rare event that needs prompt treatment. We report the case of a 71-year-old man with an aortobifemoral graft that was complicated by an uninfected proximal anastomotic pseudoaneurysm with double focal vertebral body erosion., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Rupture of a popliteal artery aneurysm is an uncommon event in an uncommon disease. We present the case of an 88-year-old female with a ruptured popliteal artery aneurysm that was diagnosed by multidetector computed tomography and treated by an endovascular approach., Competing Interests: The authors declare no conflict of interest related to this article., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Biliary leakage complicating hepaticojejunostomy is a therapeutic dilemma for surgeons, gastroenterologist, and interventional radiologist. It is a major cause of postoperative morbidity. Percutaneous biliary intervention techniques have been developed for treating benign post-surgical biliary disease in patients not having severely compromised clinical conditions. Interventional radiology manoeuvres are especially indicated as the first line of treatment if endoscopic procedures are unfeasible for patients due to postsurgical anatomical modifications. We present a case of post-surgical complete hepaticojejunostomy dehiscence that was treated totally by percutaneous techniques with trans-hepatic rescue and hepaticojejunostomy neo-creation.

A 77-year-old woman with a 1 years history of Multiple Myeloma (MM) presented with headache, fatigue, and bone pain. She underwent whole body multi-detector computed tomographic (MD-CT) to evaluate possible lytic bone lesions. MD-CT showed small, multiple osteolytic lesions, particularly at the skull level (Figure 1, 2). MM is a plasma cell disorder. It is characterized by the monoclonal proliferation of malignant plasma cells (1,2). These cells, among their various characteristics, determine an infiltrate haemopoietic locations (1). Pathogenesis of MM related bone disease is the uncoupling of the bone remodelling process. There is an increased activity of osteoclastogenesis with the suppressed osteoblastic one, resulting in bone loss (1- 3). This process creates lytic lesions without reactive bone formation (2). Bone disease could be from single lytic lesion to multiple lytic lesions affecting any part of skeleton, preferably skull, spine and long bones (3). MD-CT, with dedicated low-dose protocols, is able to provide whole body skeletal volume information with a greater sensitivity than conventional X-ray studies in MM patients (3). Whole body CT with lowdose protocols can detect lesions with less than 5% trabecular bone destruction, and it is the first-line diagnostic imaging procedure for the diagnosis of lytic bone disease in patients affected by MM (4). When skull is involved, its most common MD-CT presentation is by numerous, well-circumscribed and punched-out lytic bone lesions, without reactive bone formation and diffuse osteopenia (1-5), as in the case presented.

We report the case of a 73-year-old male who underwent abdominal multidetector computed tomography with vascular reconstruction that highlighted a congenital variant of iliac arteries. Iliac artery anatomical variants are exceedingly rare and only a few cases have been reported in the literature., Competing Interests: The authors declare no conflict of interest related to this article., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Renal artery occlusion is a serious event that can result in significant impairment or loss of renal function, leading to dialysis dependency. The nonspecific signs and symptoms of its presentation frequently result in a delay in diagnosis, thus contributing to delay in treatment. We report the case of a 53-year old woman who suffered renal artery occlusion, in which the renal perfusion was restored after three days of ischemia, by endovascular aspiration thrombectomy., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Published by Elsevier Inc.)

Introduction: The removal of an encrusted nephrostomy tube can be a challenging maneuver. Urological literature is very bare in detailing techniques for removal of entrapped percutaneous catheters. We present a simple, safe and non-invasive technique of nephrostomy removal using a vascular introducer sheath, useful to manage complicated situations such as nephrostomies blocked for severe encrustations or disabled in their self-locking system., Surgical Technique: The nephrostomy tube is cut and the stump is passed with a suture needle. The suture is passed through the inner vascular introducer sheath tip, and the introducer is then removed. The introducer sheath is advanced over the nephrostomy until joining the pigtail segment, under fluoroscopy guidance. Thus the suture is pulled out with strenght to contrast the opposite stiffness of the encrusted coil, until the nephrostomy has safely come out., Comment: The sheath exchange technique is quick, involves less manipulation through the perirenal fascia and kidney, and is suitable for different conditions of entrapped nephrostomies.

Percutaneous endovascular abdominal aortic aneurysm repair is nowadays considered a safe and effective procedure and has gained widespread globally acceptance. However, intraoperative persistent bleeding due to percutaneous access closure device failure can occur. Open conversion is first-line treatment to manage this complication. The fascia suture technique was introduced as an alternative to access closure device or as a solution to manage unsatisfactory hemostasis during percutaneous endovascular abdominal aortic aneurysm repair. In this article, we report a new simple minimally invasive ultrasound-guided fascia suture technique as a bailout method to manage persistent bleeding after percutaneous endovascular abdominal aortic aneurysm repair avoiding open conversion. This technique was successfully used in two cases at our center with satisfactory hemostasis and no further complications. Ultrasound-guided fascia suture technique can be proposed as a minimally invasive bailout technique for access closure device failure.

Facial ArterioVenous Malformations (AVM) are rare lesions and present great difficulty in their diagnosis and treatment. We report a case of a 24-year-old male who has been diagnosed a right facial AVM that underwent endovascular embolization with a liquid embolic device and consequently surgical resection. The type of liquid embolic device used has given advantage for both treatment techniques.

Artificial intelligence (AI) is revolutionizing healthcare and transforming the clinical practice of physicians across the world. Radiology has a strong affinity for machine learning and is at the forefront of the paradigm shift, as machines compete with humans for cognitive abilities. AI is a computer science simulation of the human mind that utilizes algorithms based on collective human knowledge and the best available evidence to process various forms of inputs and deliver desired outcomes, such as clinical diagnoses and optimal treatment options. Despite the overwhelmingly positive uptake of the technology, warnings have been published about the potential dangers of AI. Concerns have been expressed reflecting opinions that future medicine based on AI will render radiologists irrelevant. Thus, how much of this is based on reality? To answer these questions, it is important to examine the facts, clarify where AI really stands and why many of these speculations are untrue. We aim to debunk the 6 top myths regarding AI in the future of radiologists.

We report a case of a 45-year-old male suffering from arterial hypertension who was found to have an aortic coarctation with marked hypertrophic compensatory collateral arterial circulation. Although coarctation is relatively rare, this must be included in the differential diagnosis in patients with arterial hypertension with a positive gradient between upper and lower limbs., Competing Interests: The authors do not report any conflict of interest related to this article., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

The aim of our study is a retrospective evaluation of effectiveness and safety of Computed Tomography (CT)-guided radiofrequency ablation (RFA) therapy of primary and metastatic lung lesions in patients that cannot be considered surgical candidates. From February 2007 to September 2017, we performed 264 CT-guided ablation sessions on 264 lesions in 174 patients (112 M and 62 F; mean age, 68 years; range 36-83 years) affected by primary and metastatic lung lesions. The 45% of patients was affected by primary lung cancer, with size range lesion of 10-50 mm, and the 55% by metastatic lung lesions with size range of 5-49 mm. All patients had no more than three metastases in the lung and pulmonary relapses were treated up to three times. Overall Survival (OS), Progression-Free Survival (PFS), Local Progression-Free Survival (LPFS) and Cancer-specific survival (CSS) at 1, 3 and 5 years were calculated both in primary lung tumors and in metastatic patients. Immediate and late RFA-related complications were reported. Pulmonary function tests were evaluated after the procedures. The effectiveness of RFA treatment was evaluated by contrast-enhanced CT. In patients affected by primary lung lesions, the OS rates were 66.73% at 1 year, 23.13% at 3 years and 16.19% at 5 years. In patients affected by metastatic lung lesions, the OS rates were 85.11%, 48.86% and 43.33%, respectively, at 1, 3 and 5 years. PFS at 1, 3 and 5 years were 79.8%, 60.42%, 15.4% in primary lung tumors and 78.59%, 51.8% and 6.07% in metastatic patients. LPFS at 1, 3 and 5 years were 79.8%, 64.69%, 18.87% in primary lung tumors and 86.29%, 69.15% and 44.45% in metastatic patients. CSS at 1, 3 and 5 years was 95.56%, 71.84%, 56.72% in primary lung tumors and 94.07%, 71% and 71% in metastatic patients. Immediate RFA-related complications (pneumothorax, pleural effusion and subcutaneous emphysema) were observed, respectively, in 42, 53 and 13 of 264 procedures (15.9%, 20% and 5%). There also occurred one major complication (lung abscess, 0.36%). No significant worsening of pulmonary function was noted. Our retrospective evaluation showed long-term effectiveness, safety and imaging features of CT-guided RFA in patients affected by primary and metastatic lung cancer as an alternative therapy in non-surgical candidates.

Renal cell carcinoma (RCC) local recurrence after radical nephrectomy is uncommon. When feasible, surgical removal remains the primary treatment strategy; nevertheless, local RCC relapse management is controversial, and less invasive procedures may represent an attractive option to achieve oncologic control. The aim of our study was to assess the feasibility, safety, and clinical outcomes of image-guided percutaneous microwave ablation (MWA) for RCC local recurrence in patients initially treated with nephrectomy with curative intent. 10 consecutive patients underwent CT-guided percutaneous MWA of a total of 10 retroperitoneal nodules. Inclusion criteria were: histologically verified retroperitoneal metastases, previous radical nephrectomy, lesion no larger than 3 cm, no other metastatic site elsewhere. All the procedures were performed under moderate sedation choosing the most favorable patient decubitus. If deemed necessary, pneumodissection was induced before ablation. After the antenna placement inside the target lesion, thermal ablation was achieved by maintenance of a power of 100 W for a total time between 2 and 4 min. All patients were observed overnight and discharged the following day if clinically stable. Technical success was obtained in 100% of patients. One patient was re-treated to complete oncologic response with repeat MWA. No major complications were observed. No patients demonstrated local recurrence at a mean follow-up of 26 months. MWA is a safe and effective treatment strategy for loco-regional relapse of RCC following radical nephrectomy. This technique may represent a valuable approach for patients who are not eligible for surgery.

A 77-year-old woman with a history of hypertension developed acute onset of aphasia and right hemiplegia and hemisensory loss. She was urgently referred to emergency department. Cerebral multidetector computed tomographic angiography (MD-CTA) revealed an acute ischemic stroke due to the occlusion of the left middle cerebral artery (Figure 1). Since the symptoms started three hours previously, the patient was candidate for mechanical thrombectomy. The patient then performed a selective digital subtraction angiography (DSA) of the left internal carotid artery that confirmed occlusion of the ipsilateral middle cerebral artery (Figure 2) and subsequently successfully performed the endovascular mechanical thrombectomy (Figure 2). Her clinical course has shown neurological symptoms improvement over time. Acute ischemic stroke can be caused by several factors, but the main ones are arterial and cardiac embolism, arterial wall disease or variants(1-4). The National Institutes of Health Stroke Scale (NIHSS) score, is widely used as clinical assessment for neurological deficits related to ischemic stroke(1). MDCTA and Magnetic Resonance Imaging are the two gold standard methods for diagnosis in acute ischemic stroke patients(1-5). Thrombolytic therapy of this pathological state began in the fifties, while the endovascular mechanical thrombectomy was defined as a new standard of care in 2015(1,5,6). This recent technique have added tissue window" to the existing "time window" (5,6). So, nowadays patients with small ischemic core, large penumbra, and good collaterals vessel may benefit from endovascular mechanical thrombectomy(1,5,6); even if they arrive within 6-24 h of stroke onset(5.

ation. No significant past medical history except for pharmacologically controlled mild hypertension. During the neurological examination the patient appeared alert, oriented and showed no deficit of strength, sensitivity and coordination. An expressive temporary aphasia was confirmed and Transient Ischemic Attacks (TIA) was suspected. Cranial Computed Tomography Angiography (CTA) showed hypoplasia of left Internal Carotid Artery (ICA) with a focal duplication in the intracavernous segment (Figure 1, arrowhead). Circle of Willis appears to be regular, with the left middle cerebral artery supported by the vertebrobasilar system through the left posterior communicating artery of increased caliber, and by the contralateral ICA via anterior communicating artery. Consequently, patient underwent Digital Subtraction Angiography (DSA) lateral view that confirmed the segmental duplication of the left intracavernous ICA (Figure 2, arrowhead). Vessels had a lightly winding course within the cavernous sinus and the intracranial branches downstream of their confluence presented a slight delay in visualization. After few hours her symptoms completely regressed and, in agreement with clinical and imaging data, diagnosis of TIA was made. The transient ischemic event was, in fact, most likely caused by low flow to the left cerebral hemisphere due to hypoplasia of the ICA and aforementioned abnormalities of its intracavernous tract that caused alteration and reduction of intracranial flow distribution. Medical treatment with anti-platelet drugs was started and patient was discharged with a clinical, laboratory and imaging follow-up program. Duplications of ICA in the intracranial tract are very rare(1,2). Most of the cases are localized in the supraclinoid segment. To our knowledge this is the first case described in literature of true duplication of ICA in the intracavernous tract. Patients with congenital variants or acquired pathology of ICA are mostly asymptomatic, but when symptoms appear, patients must be investigated(1-3). CTA is considered the first line non-invasive diagnostic method for intracranial vascular anatomy. At present, medical treatment remains the choice in patients with no-complicated duplications of ICA in the intracranial tract.

Hepatic haemangioma is a congenital vascular malformation, considered the most common benign mesenchymal hepatic tumour. Spontaneous or traumatic rupture is the most severe complication. In case of rupture, surgical resection and enucleation, as a single therapy or after trans-arterial embolization are considered the treatments of choice. We report a case of spontaneous rupture of a hepatic haemangioma with massive hemoperitoneum successfully treated by percutaneous hepatic trans-arterial embolization and pelvic drainage alone.

We report a case of right renal artery originating from the thoracic aorta with normal position of the right kidney. Although this anomaly is rare, vascular, thoracic, and urological surgeons should be aware about this vascular variant before planning their surgical intervention., Competing Interests: The authors declare no conflict of interest related to this article., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Chimney-and-periscope technique for thoraco-abdominal aneurysm repair is a valuable treatment option in selected patients. Acute renal artery occlusion is a serious complication after this technique. We report a case of acute right renal artery occlusion, consequent to a previous chimney-and-periscope technique that was treated urgently by mechanical aspiration thrombectomy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: To evaluate role of interventional radiology (IR) in post-surgical haemorrhagic complications of prostatectomy., Methods: A retrospective study was performed. From April 2015 to January 2018, 10 patients referred to IR Department for haemorrhagic complications post radical prostatectomy (RP). All patients (mean age: 68.5 years; range, 58-85 years) were successfully treated with superselective trans-arterial embolization. We evaluated technical and clinical success and post procedural complications., Results: Technical and clinical success was 100% (10/10) and no major complications were identified. No complications related to the endovascular procedures occurred. No recurrences during follow-up (8-20 months) were observed. Among minor complications, only 20% (2/10) developed mild post embolization syndrome., Conclusions: The endovascular management of significant haemorrhage after prostatectomy is safe and long-term effective, with no major ischaemic events associated to embolization., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

The presence of an intravascular foreign body represents a well-known risk of serious complications. While in the past surgical removal of intravascular foreign body was the most common intervention, nowadays a percutaneous approach in the retrieval of an intravascular foreign body is widely accepted as the first-line technique. In the literature, many case reports describe different techniques and materials. This article summarizes and illustrates the main materials and techniques currently applied for percutaneous retrieval of intravascular foreign body, providing a simplified tool with different interventional possibilities, adaptable to different clinical situations.