Journal of Vascular and Interventional Radiology最新文献

{"title":"Ketamine/Midazolam versus Fentanyl/Midazolam Procedural Sedation for Interventional Radiology: A Prospective Registry.","authors":"G Fabio Greco, Zayd Al-Asadi, Adam M Belcher, Elaine Mattox, Michael Korona, Amy R Deipolyi","doi":"10.1016/j.jvir.2025.01.050","DOIUrl":"https://doi.org/10.1016/j.jvir.2025.01.050","url":null,"abstract":"<p><strong>Purpose: </strong>The study assessed whether sedation with ketamine/midazolam was more effective than fentanyl/midazolam at reducing peri-procedure pain scores for interventional radiology (IR) procedures.</p><p><strong>Materials and methods: </strong>Pre-, intra-, and post-procedure pain scores, procedure duration, and moderate or worse adverse events were collected as part of a prospective quality improvement registry before and after the introduction of a ketamine/midazolam sedation program at a single academic center, including 292 procedures performed on adult patients from 4/2024 to 8/2024. All IR staff were surveyed before and after the introduction of ketamine regarding their observations on sedation, with 23 respondents at baseline survey and 22 at follow-up.</p><p><strong>Results: </strong>Compared to fentanyl/midazolam sedation, ketamine/midazolam sedation was associated with lower intra- (P≤0.0001) and post-procedure (P≤0.05) pain scores, without prolonging procedure duration (P=0.4362) or increasing adverse events (P>0.999). The effect on pain scores was observed for biopsy and drainage, but not venous port procedures. Staff reported that ketamine/midazolam sedation provided adequate comfort more often than fentanyl/midazolam sedation (P≤0.01), and at study conclusion, most (82%) reported that they would choose ketamine/midazolam sedation for themselves.</p><p><strong>Conclusion: </strong>Compared to fentanyl/midazolam, ketamine/midazolam sedation is superior regarding reduction of patient discomfort and preference by IR staff, with no added procedural duration or adverse events when administered in the absence of anesthesiology providers. Findings suggest further investigation into incorporating ketamine into routine use in IR programs.</p>","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Cancer Recurrence After Cryoablation in Patients Who are Poor Surgical Candidates or Who Refuse Surgery.","authors":"Jolie Jean, Maxine S Jochelson, Tracy-Ann Moo, Stephen B Solomon, Yolanda Bryce","doi":"10.1016/j.jvir.2025.01.048","DOIUrl":"https://doi.org/10.1016/j.jvir.2025.01.048","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate in-breast recurrence rates after cryoablation in patients with primary breast cancer who were poor surgical candidates or refused surgery.</p><p><strong>Materials & methods: </strong>Patients with primary breast cancer who were poor surgical candidates or who refused surgery and were treated with cryoablation at a single academic cancer center between October 2018-June 2023 were retrospectively reviewed. Out of the sixty treated patients, 45 had invasive ductal carcinoma (IDC), 6 patients had invasive lobular carcinoma, 2 patients had multicentric ductal carcinoma in situ (DCIS), and 7 patients had other histology. Tumor size ranged from (0.3-9cm), with a mean of 2.7cm. Recurrence was defined as new tumor or regrowth of residual tumor in the ipsilateral breast.</p><p><strong>Results: </strong>With a mean follow up of 21 months and median follow up of 9.8 months, there was a recurrence rate of 10% (6/60 patients). Patients in the recurrence group had more poorly differentiated disease than those in the non-recurrence group (66.7% vs. 22.2%, p= 0.038). Tumor size did not differ between non-recurrence and recurrence groups (no recurrence group mean 2.7 ± 2.6cm, recurrence group mean 2.5 ± 1.0cm, p = 0.506). Patients who were treated with palliative intent rather than curative intent were significantly older (79.7 ± 12.2 vs. 72.5 ± 11.3, p = 0.032).</p><p><strong>Conclusion: </strong>Cryoablation can be considered in patients who are poor surgical candidates or who refuse surgery, with a 10% recurrence rate at a mean follow up of 21 months in this retrospective review that included patients with tumors up to 9 cm, unfavorable pathology, and multicentric disease.</p>","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subscription Information Page","authors":"","doi":"10.1016/S1051-0443(24)00794-2","DOIUrl":"10.1016/S1051-0443(24)00794-2","url":null,"abstract":"","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"36 2","pages":"Page A2"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143169239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Nephrostomy Access for the Placement of Bilateral Ureteral Stents","authors":"Laura Manuela Olarte Bermúdez MD ,&nbsp;Laura Andrea Campaña Perilla MD ,&nbsp;David Fernando Torres Cortes MD ,&nbsp;Oscar Mauricio Rivero Rapalino MD","doi":"10.1016/j.jvir.2024.10.024","DOIUrl":"10.1016/j.jvir.2024.10.024","url":null,"abstract":"","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"36 2","pages":"Pages 368-369"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perigraft Endoleak Embolization Following Stent Graft Repair of a Pulmonary Artery Pseudoaneurysm","authors":"Matthew L. Hung MD ,&nbsp;Kevin C. Ma MD ,&nbsp;Anthony R. Lanfranco MD ,&nbsp;Timothy W.I. Clark MD ,&nbsp;Ansar Z. Vance MD","doi":"10.1016/j.jvir.2024.10.027","DOIUrl":"10.1016/j.jvir.2024.10.027","url":null,"abstract":"","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"36 2","pages":"Pages 363-366"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resin-Based Yttrium-90 Radioembolization as a Bridging or Downstaging Treatment to Liver Transplantation for Hepatocellular Carcinoma","authors":"Lawrence Bonne MD ,&nbsp;Christophe M. Deroose MD, PhD ,&nbsp;Chris Verslype MD, PhD ,&nbsp;Diethard Monbaliu MD, PhD ,&nbsp;Jeroen Dekervel MD, PhD ,&nbsp;Charlotte Van Laeken MD ,&nbsp;Vincent Vandecaveye MD, PhD ,&nbsp;Annouschka Laenen PhD ,&nbsp;Jacques Pirenne MD, PhD ,&nbsp;Geert Maleux MD, PhD","doi":"10.1016/j.jvir.2024.10.021","DOIUrl":"10.1016/j.jvir.2024.10.021","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the outcomes of resin-based yttrium-90 (⁹⁰Y) transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) as a bridging or downstaging therapy to liver transplantation (LT) in terms of safety, tumor response, recurrence, and survival.</div></div><div><h3>Materials and Methods</h3><div>A single-center retrospective analysis of patients with HCC treated with resin-based TARE as bridging or downstaging treatment to LT between January 2006 and April 2021 was performed. TARE-related liver toxicity was assessed. Imaging data were analyzed to assess tumor response. Histopathological analysis of explant livers was performed to assess HCC necrosis. Survival and bridging/downstaging success predictor analysis was performed.</div></div><div><h3>Results</h3><div>Thirty-six patients underwent resin-based TARE with the intention to bridge (33%) or downstage (67%) to LT. Overall, 44% had ≥3 HCC lesions, and 53% had bilobar disease. Median largest tumor diameter was 3.4 cm. TARE was segmental, lobar, and bilobar in 20%, 36%, and 44% of cases, respectively. In total, 17% had Grade 3 bilirubin toxicities. The objective response rate per modified Response Evaluation Criteria in Solid Tumours was 72%. Patients meeting the United Network for Organ Sharing Downstaging criteria had higher chances of successful bridging/downstaging. Twenty-three patients were transplanted. Complete pathological response was noted in 30% of explant livers. Posttransplant tumor recurrence occurred in 26% within a median follow-up period of 1,710 days. Estimated 5-year progression-free, disease-specific, and overall survival rates after LT were 89%, 69%, and 89%, respectively. For the entire patient cohort, these survival rates were 87%, 53%, and 70%, respectively.</div></div><div><h3>Conclusions</h3><div>Resin-based ⁹⁰Y TARE can be considered a valuable treatment option for bridging or downstaging patients with HCC to LT, including patients requiring lobar or bilobar TARE for extensive tumoral disease.</div></div>","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"36 2","pages":"Pages 282-292"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yttrium-90 Radiation Segmentectomy for Treatment of Neuroendocrine Liver Metastases","authors":"Andrew C. Gordon MD, PhD ,&nbsp;Rohan Savoor MD ,&nbsp;Sheetal M. Kircher MD ,&nbsp;Aparna Kalyan MD ,&nbsp;Al B. Benson III MD ,&nbsp;Elias Hohlastos MD ,&nbsp;Kush R. Desai MD ,&nbsp;Kent Sato MD ,&nbsp;Riad Salem MD, MBA ,&nbsp;Robert J. Lewandowski MD","doi":"10.1016/j.jvir.2024.11.003","DOIUrl":"10.1016/j.jvir.2024.11.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the safety and effectiveness of yttrium-90 (⁹⁰Y) radiation segmentectomy (RS) for neuroendocrine tumor liver metastases (NELMs).</div></div><div><h3>Materials and Methods</h3><div>This single-institution retrospective study included 18 patients with 23 liver tumors not amenable to resection or ablation, who underwent RS between 2009 and 2021. Tumor grades by Ki-67/mitotic indices were Grade I (n = 9/23, 39%), Grade II (n = 10/23, 45%), and Grade III (n = 4/23, 17%). Eleven patients (61%) were previously treated with somatostatin analogs, 5 (28%) with chemotherapy, and 2 (11%) with peptide receptor radionuclide therapy. Safety was assessed with preprocedural/postprocedural liver chemistries, blood counts, and clinical adverse events (AEs) using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Tumor response was assessed per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and modified RECIST (mRECIST) criteria. Kaplan-Meier analysis was used to estimate median overall survival (OS), progression-free survival (PFS), and time to progression (TTP) from the date of ⁹⁰Y.</div></div><div><h3>Results</h3><div>Median follow-up was 31.9 months. Grade 1 fatigue was observed in 13 of 18 patients (72%), with 1 of 18 patients (6%) experiencing Grade 3 fatigue. Three patients (17%) exhibited Grade 3 lymphopenia. No other Grade 3 or any Grade 4 AE was observed. Tumor objective response was achieved in 83% of patients by RECIST size criteria and 100% by mRECIST enhancement criteria. Median OS was 69.4 months (95% CI, 23.1–99.4), and median PFS was 12.2 months (95% CI, 4.6–28.8). Median overall TTP was 13.0 months (95% CI, 4.6–45.1), with median treated tumor TTP not reached.</div></div><div><h3>Conclusions</h3><div>⁹⁰Y RS demonstrated high rates of antitumor response with a favorable toxicity profile and durable OS in the treatment of NELMs.</div></div>","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"36 2","pages":"Pages 293-300"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redistribution and Embolization of a Uterine Fibroid with Ovarian Arterial Supply Using Temporary Bilateral Ovarian Artery Microballoon Occlusion","authors":"Satoshi Tsuchiya MD, PhD ,&nbsp;Jun Koizumi MD, PhD ,&nbsp;Takashi Takeuchi MD ,&nbsp;Satoru Mikami MD ,&nbsp;Takashi Uno MD, PhD","doi":"10.1016/j.jvir.2024.11.006","DOIUrl":"10.1016/j.jvir.2024.11.006","url":null,"abstract":"","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"36 2","pages":"Pages 366-368"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thirty-Day Healthcare Encounters after Elective Uterine Artery Embolization for Fibroids with and without Superior Hypogastric Nerve Block","authors":"Nicole H. Kim MD ,&nbsp;Ammar Sarwar MD ,&nbsp;Muhammad Mohid Tahir MD ,&nbsp;Razan Ali BS ,&nbsp;Sarah E. Schroeppel DeBacker MD ,&nbsp;Salomao Faintuch MD ,&nbsp;Olga R. Brook MD ,&nbsp;Julie C. Bulman MD","doi":"10.1016/j.jvir.2024.10.019","DOIUrl":"10.1016/j.jvir.2024.10.019","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate how the implementation of superior hypogastric nerve block (SHNB) during uterine artery embolization (UAE) for uterine fibroids impacts same-day discharge and healthcare encounters (HCEs) within 30 days.</div></div><div><h3>Materials and Methods</h3><div>A total of 240 patients who underwent successful UAE for fibroids between January 2018 and December 2022 were retrospectively reviewed. HCEs within 30 days, including emergency department and urgent care visits, admissions, and readmissions, were categorized as early (0–7 days of discharge) and late (8–30 days of discharge) and related or unrelated to interventional radiology (IR) care. Factors associated with same-day discharge and HCE were identified using univariate analyses. Rates of HCE based on SHNB status were compared using the chi-square tests.</div></div><div><h3>Results</h3><div>The mean age of the patients was 46 years (SD ± 5); 125 patients received UAE with SHNB. Patients who underwent SHNB were significantly more likely to undergo same-day discharge (113/125, 90%) than those without SHNB (55/115, 48%) (<em>P</em> &lt; .001). No factors were associated with rates of all-cause 30-day HCE, including SHNB status (SHNB, 17% [21/125], versus no SHNB, 10% [12/115]; <em>P</em> = .20). A majority of HCEs were due to an IR-related cause (26/33, 79%), including abdominal or pelvic pain (22/33, 67%); nausea, vomiting, or poor oral intake (18/33, 55%); and vaginal bleeding (4/33, 12%). Comparison of patients who underwent SHNB with those without SHNB showed no difference in the proportion of IR-related HCE (17/21 [81%] versus 9/12 [75%], <em>P</em> = .69).</div></div><div><h3>Conclusions</h3><div>UAE with SHNB was associated with significantly higher rates of same-day discharge but similar rates of 30-day HCEs compared with UAE alone.</div></div>","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"36 2","pages":"Pages 247-254.e3"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CME Test Questions: February 2025","authors":"","doi":"10.1016/j.jvir.2024.12.017","DOIUrl":"10.1016/j.jvir.2024.12.017","url":null,"abstract":"","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"36 2","pages":"Page 255"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143169224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}