1,721,045 research outputs found
Balloon-occluded TACE
No full textTACE procedures are performed with the use of microcatheters for accurate and selective delivery of chemotherapy. Microcatheters with distal micro-balloon are used for both cTACE and DEM-TACE, allowing to obtain a flow redistribution toward the tumor with consequent advantages on oncological efficacy. This chapter illustrates the evidence about this technique’s performance compared with standard microcatheter procedures and gives tips and tricks for a successful balloon-occluded TACE. Details for proper microcatheter placement, for performing correct priming and an effective inflation of the micro-balloon (explaining its relation to balloon-occluded arterial stump pressure), and to understand the endpoint of the procedure are discussed
Rationale, definition, and history of transarterial chemoembolization
No full textTransarterial chemoembolization (TACE) is a
minimally invasive technique used for the treatment of liver’s malignancies, mostly hepatocellular carcinoma (HCC). TACE allows
administration of chemotherapy, carried in a mixture with Lipiodol (conventional TACE,
C-TACE), or by drug-eluting beads (drug-eluting
microsphere, DEM-TACE) [1], directly into the
liver tumor’s feeding vessels [2, 3]. TACE has
been used in palliative treatments and unresectable HCC since the beginning of this centur
Identifying the Learning Curve for Uterine Artery Embolisation in an Interventional Radiological Training Unit
No full text
Acute Left Arm Ischemia Associated with Floating Thrombus in the Proximal Descending Aorta: Combined Endovascular and Surgical Therapy.
No full textFree floating thrombus in the proximal descending aorta is an uncommon and dangerous condition that can be associated with acute peripheral embolization. The few cases described were solved with surgical and/or medical therapy. We report the case of a patient with acute left arm ischemia secondary to the presence of floating thrombus in the proximal descending aorta extending into the left subclavian artery, solved with combined endovascular and surgical therapy. Treatment was successfully performed with thrombembolectomy combined with temporary deployment, into the descending aorta, of a Wallstent in a "basket-fashion" to avoid distal embolization secondary to thrombus fragmentation. At 1 year follow-up the patient remained symptom-free
Impact of 3D Rotational Angiography on Liver Embolization Procedures: Review of Technique and Applications
No full textIn the last years, the interest into interventional applications of C-arm
cone-beam CT (CBCT) progressively raised, widening its clinical application from
the original field of interventional neuroradiology to the field of peripheral
procedures. Liver embolization procedures, due to their complexity and potential
treatment-related life-threatening complications, represent one of the main
clinical applications of this novel angiographic technique. CBCT has been
demonstrated to render procedures safer and technically easier, and to predict
outcome as well as to avoid major complications in different treatment scenarios
(trans-arterial embolization, trans-arterial chemoembolization, selective
internal radiation therapy, percutaneous portal vein embolization). This review
summarizes all technical, dosimetric and procedural aspects of CBCT techniques,
underlying all its potential clinical advantages in the field of liver
embolization procedures. Moreover, the paper provides all the instructions to
obtain the best diagnostic performance out of this novel angiographic technique
Role of CT and MR imaging in the assessment of suspected spondylodiscitis and planning of needle biopsy
No full textPurpose Our aim was to assess the role of computed tomography (CT) or magnetic resonance imaging (MRI) in the assessment of spondylodiscitis, identifying the best target structures for biopsy to increase the likelihood of positive cultures. Materials and methods This study was approved by our Institutional Review Board, and requirement for specific consent form was waived. In this retrospective single Institution study, we evaluated clinical and imaging records of 60 patients who underwent spine biopsy for suspected spondylodiscitis from January 2016 to May 2021. CT and MRI sensitivity and inter-reader agreement were assessed according to the phase of spondylodiscitis, defined as acute, subacute or chronic. Inter-reader agreement for the diagnosis and identification of spondylodiscitis phase was assessed using K statistics. Univariate logistic regression analysis was performed to assess any relationship between MRI/CT findings, spondylodiscitis phase and positive cultures. Results Sixty patients (48 males) with mean age 59, 2 +/- 29 were enrolled in this study. MRI showed higher sensitivity (96% vs 65% of CT) in the diagnosis and good inter-reader agreement (k = 0.8) in the identification of the acute and subacute phase of spondylodiscitis, and moderate inter-reader agreement (k = 0.7) and lower sensitivity (80% vs 95% of CT) for the chronic phase. Univariate analysis showed as MRI-specific findings such as extensive hyperintensity of vertebral body and/or disc on Short Tau Inversion Recovery-T2w images, paravertebral collections, preserved or augmented disc height and presence of a vertebral fractures were mainly found in the acute/subacute phase and was a predictor for positive cultures (p < 0.05). Conclusion MRI and CT are both able to identify the different phases of spondylodiscitis, although MRI is more sensitive in the acute phase. Findings such as extensive hyperintensity of the disc/vertebral body, fractures and paravertebral collections, represent the main targets for biopsy related to a positive culture
Management of refractory hepatic encephalopathy after insertion of TIPS: Long-term results of shunt reduction with hourglass-shaped balloon-expandable stent-graft
No full textOBJECTIVE. The purpose of this study was to review the use of an hourglass-shaped expanded polytetrafluoroethylene (ePTFE) stent-graft to reduce transjugular intrahepatic portosystemic shunts in patients with hepatic encephalopathy refractory to conventional medical therapy. MATERIALS AND METHODS. From January 2000 through December 2008, 189 transjugular intrahepatic portosystemic shunt procedures were performed with self-expanding stent-grafts. After a mean period of 43.4 ± 57 weeks, hepatic encephalopathy developed in 12 patients and did not respond to conventional medical therapy with lactulose, nonabsorbable antibiotics, and a protein-restricted diet. In all cases, shunt reduction was performed with an hourglass-shaped balloon-expandable ePTFE stent-graft inserted into the original shunt. RESULTS. Technically successful shunt reduction with an immediate increase in portosystemic gradient was achieved in all patients. Symptoms of hepatic encephalopathy disappeared a mean of 22.3 hours (range, 18-26 hours) after the procedure. After a mean followup period of 73.9 ± 61.88 weeks, no recurrence of hepatic encephalopathy was found. One patient (8.3%) needed dilation of the hourglass-shaped stent-graft after 37 weeks because of recurrence of ascites. At the end of the study, five patients (41.6%) were alive in good clinical condition. Four patients (33.3%) died of cardiovascular failure 1, 2, 24, and 96 weeks after the corrective procedure. Eight months after the reduction procedure, one patient (8.3%) underwent orthotopic liver transplantation, which resulted in clinical improvement. Two patients (16.6%) were lost to follow-up 15.6 and 46.8 weeks after the procedure. CONCLUSION. Shunt reduction with an hourglass-shaped ePTFE balloon-expandable stent-graft seems effective in reducing shunt flow and rapidly improving the patient's clinical condition. With this technique, shunt diameter can be modified on the basis of the patient's clinical condition. © American Roentgen Ray Society
- …
