Techniques in Vascular and Interventional Radiology最新文献

{"title":"Interventional Radiology Management of Pediatric Portal Venous Pathologies","authors":"Jakob Spogis MD ,&nbsp;Gerd Grözinger MD","doi":"10.1016/j.tvir.2025.101085","DOIUrl":"10.1016/j.tvir.2025.101085","url":null,"abstract":"<div><div>Portal venous pathology is a leading cause of prehepatic portal hypertension in children, most often resulting from portal vein thrombosis (PVT), either in the native liver or following liver transplantation. While surgical shunts such as the Meso-Rex shunt and Warren shunt remain the first-line therapy, interventional radiology (IR) now plays a central role in primary and adjunctive treatment strategies. This review outlines current IR techniques for managing pediatric portal venous disorders. These include portal vein recanalization (PVR), salvage of thrombosed Meso-Rex and Warren shunts, and transjugular intrahepatic portosystemic shunt (TIPS) placement. Technical aspects are emphasized, including pediatric-specific access strategies (eg, translienal puncture, CBCT guidance, wire targeting, and stent selection), and outcome data are presented where available.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 4","pages":"Article 101085"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Portal Hypertension in Oncologic Patients","authors":"James Frencher MD, PhD,&nbsp;Monica Chavan MD,&nbsp;Jordan Ellis MD,&nbsp;Baljendra Kapoor MD","doi":"10.1016/j.tvir.2025.101088","DOIUrl":"10.1016/j.tvir.2025.101088","url":null,"abstract":"<div><div>Portal hypertension significantly impacts the management and prognosis of patients with primary and secondary hepatic malignancies. Its presence may preclude curative surgical or locoregional therapies, increase perioperative risk, and worsen overall survival. Interventional radiology plays a central role in the management of portal hypertensive complications when medical and endoscopic therapies are insufficient. The mainstay intervention, transjugular intrahepatic portosystemic shunt (TIPS), is well-established for variceal bleeding, refractory ascites, and hepatic hydrothorax in cirrhotic patients, and emerging evidence supports its use in selected cancer patients, including those with hepatocellular carcinoma (HCC) and metastatic disease. Splenic artery embolization (SAE) serves as an alternative or adjunctive therapy in patients with contraindications to TIPS, in individuals who have persistent symptoms despite TIPS placement. This document outlines evidence-based management strategies for portal hypertension in cancer patients and discusses technical considerations in TIPS placement and splenic artery embolization.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 4","pages":"Article 101088"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Augmentation: Rationale, Current Status, and Future Directions","authors":"Jirapa Chansangrat MD ,&nbsp;Sameer Gadani MD, FSIR","doi":"10.1016/j.tvir.2025.101086","DOIUrl":"10.1016/j.tvir.2025.101086","url":null,"abstract":"<div><div>Liver augmentation techniques are critical in managing primary liver cancer and liver metastases, particularly for patients with insufficient future liver remnants (FLR). These methods aim to reduce the risk of post hepatectomy liver failure (PHLF), a major cause of postoperative mortality. Techniques such as portal vein embolization (PVE), liver venous deprivation (LVD), and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induce hypertrophy of the FLR, enabling curative surgery for patients previously deemed inoperable. Functional assessment tools, including hepatobiliary scintigraphy and MRI with hepatocyte-specific contrast, are increasingly utilized to evaluate liver function and predict postoperative outcomes. Pathophysiology and factors influencing liver regeneration including patient-specific conditions are explored. Additionally, tumor-specific considerations, such as hepatocellular carcinoma in cirrhotic livers, and biliary malignancies with cholestasis, highlight the need for tailored approaches. Emerging innovations, including artificial intelligence, show promise in improving volumetric assessments and patient selection. Advancements in liver augmentation techniques have expanded surgical eligibility, improved oncologic outcomes, and reduced complications, marking a transformative shift in the management of liver cancers.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 4","pages":"Article 101086"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portal Venous Interventions After Liver Transplantation","authors":"Andrew R. Lewis,&nbsp;Cynthia De la Garza-Ramos,&nbsp;Fatima Islam,&nbsp;Beau B. Toskich","doi":"10.1016/j.tvir.2025.101075","DOIUrl":"10.1016/j.tvir.2025.101075","url":null,"abstract":"<div><div>Altered portal venous flow after liver transplantation can result in graft dysfunction and increased patient morbidity and mortality. Endovascular techniques can optimize posttransplant portal venous perfusion, improving outcomes for liver graft recipients. The aim of this review is to discuss endovascular management of complications related to altered portal venous perfusion after liver transplantation including portal vein stenosis, portal hyperperfusion sysndrome, portal vein thrombosis, and spontaneous portosystemic shunts.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 4","pages":"Article 101075"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Liver Function Assessment in Portal Venous Interventions and Locoregional Therapies for Liver Tumors","authors":"Monika Neale DO ,&nbsp;Jirapa Chansangrat MD ,&nbsp;Amrit Khooblall MBA ,&nbsp;Nicholas Austin DO ,&nbsp;Chase J. Wehrle MD ,&nbsp;Federico Aucejo MD ,&nbsp;Ramanpreet Singh MS4 ,&nbsp;Sameer Gadani MD","doi":"10.1016/j.tvir.2025.101089","DOIUrl":"10.1016/j.tvir.2025.101089","url":null,"abstract":"<div><div>Functional liver assessment has undergone major evolution over the past 30 years. Assessment techniques have progressed from biochemical markers to advanced imaging techniques, particularly nuclear medicine imaging, to improve accuracy. The focus of assessment has also shifted from global hepatic function to precise segmental evaluation. This paradigm shift has greatly influenced liver-directed therapies such as hepatic resection, augmentation, transplantation, and interventional radiology. The aim of this review was to synthesize key developments in liver function assessment, including nuclear medicine techniques, hepatocyte-specific magnetic resonance imaging (MRI), and emerging multimodal and artificial intelligence (AI)-driven approaches. Select literature from the past three decades was examined, with an emphasis on innovations, validation studies, and clinical applications. Incorporating Tc-99 m mebrofenin hepatobiliary scintigraphy (HBS) into liver function assessment allowed quantitative, regional mapping of hepatocellular function. Gadoxetate-enhanced dynamic magnetic resonance imaging (MRI) has created an opportunity for high-contrast resolution images and noninvasive assessment of hepatocyte uptake and excretion. Novel positron emission tomography tracers such as C-11 acetate enabled the combined evaluation of parenchymal function and tumor biology. Studies exploring multimodal fusion, artificial intelligence (AI)-assisted image processing, and incorporating deep learning into predictive models for individualized risk assessment are underway. Overall, integrating anatomical and functional data has become increasingly widespread, allowing for a more precise evaluation of liver function and improvement of therapeutic outcomes. However, reproducibility, standardization, and accessibility remain potential impediments to broad implementation. Future directions for research include prospective validation studies, multimodal fusion, utilizing deep learning in risk stratification, and the development of individualized treatment strategies tailored to patient-specific risk profiles.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 4","pages":"Article 101089"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Changes in Body Composition after Transjugular Intrahepatic Portosystemic Shunt Creation on Morbidity and Mortality: A Systematic Review","authors":"Takeshi Suzuki MD, PhD,&nbsp;Khashayar Farsad MD, PhD","doi":"10.1016/j.tvir.2025.101076","DOIUrl":"10.1016/j.tvir.2025.101076","url":null,"abstract":"<div><div>Changes in body composition, including the reversal of sarcopenia, after transjugular intrahepatic portosystemic shunt (TIPS) creation have been reported to impact morbidity and mortality. This systematic review aims to identify changes in body composition that could serve as markers for post-TIPS outcomes in patients with cirrhosis. Electronic databases including Ovid Medline, Embase, and Central Register of Controlled Trials were searched from inception to February 5, 2025 to analyze the impact of changes in body composition on post-TIPS outcomes in patients with cirrhosis. A total of 16 studies were included in the review. Most studies reported that post-TIPS skeletal muscle gain often caused a reversal of sarcopenia (18%-66%) and contributed to improvements in morbidity and mortality. In particular, patients with pre-TIPS sarcopenia received the greatest benefit. Skeletal muscle index showed the most substantial increase within 6 months after TIPS creation, while the psoas muscle index or the transverse psoas muscle thickness/ height increased as early as 1-3 months after TIPS creation. Reversal of sarcopenia after TIPS creation may contribute to improvements in morbidity and mortality in cirrhosis. Skeletal muscle tends to show the most substantial increase within 6 months after TIPS creation, with the psoas muscle index observed as an early imaging biomarker. Further research is needed to identify the underlying physiologic mechanisms responsible for these observed body composition changes and to prospectively assess the impact on clinical outcomes.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 4","pages":"Article 101076"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric Varices: Anatomic Considerations and Management","authors":"Paula M. Novelli MD, FSIR,&nbsp;Philip D. Orons DO, FACOR, FSIR","doi":"10.1016/j.tvir.2025.101082","DOIUrl":"10.1016/j.tvir.2025.101082","url":null,"abstract":"<div><div>Gastric varices can pose both diagnostic challenges and serious risk of life-threatening hemorrhage in patients with cirrhotic and noncirrhotic portal hypertension. Management requires a multidisciplinary approach, with gastroenterology playing a key role in diagnosis, endoscopic assessment, and initial treatment strategies. Interventional radiology plays a pivotal role in treatment with advanced portal decompression techniques, Together, gastroenterology and Interventional radiology specialties provide an individualized patient tailored approach to optimize diagnostic and treatment strategies in patients with gastric varices. This article offers a descriptive approach to diagnosing and managing GV.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 4","pages":"Article 101082"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Applications in the Diagnosis and Management of Cirrhosis and Portal Hypertension: A Narrative Review","authors":"Amrit Khooblall MBA ,&nbsp;Satish E. Viswanath PhD ,&nbsp;Layth Khawaja BS ,&nbsp;Sameer Gadani MD, FSIR","doi":"10.1016/j.tvir.2025.101078","DOIUrl":"10.1016/j.tvir.2025.101078","url":null,"abstract":"<div><div>Cirrhosis and portal hypertension remain major challenges in interventional radiology, with current diagnostic and therapeutic approaches limited by requiring invasive assessment, variability inherent to imaging modalities, and suboptimal risk stratification. For instance, traditional risk scoring systems, such as the Model for End-Stage Liver Disease, are not sufficient to predict complications after interventions such as transjugular intrahepatic portosystemic shunt (TIPS) insertion. Similarly, imaging via Doppler ultrasound, computed tomography, and magnetic resonance imaging provide valuable insights but suffer from operator dependence, inconsistent sensitivity, and accessibility constraints. This narrative review summarizes the current state of the art with regard to leveraging artificial intelligence (AI) to diagnose and predict outcomes in patients with cirrhosis or portal hypertension as well as to optimize outcomes in patients undergoing TIPS placement for the treatment of these conditions. The implementation of AI into clinical practice could potentially significantly transform the treatment of cirrhosis and portal hypertension by optimizing diagnostic accuracy, procedural safety, and long-term outcomes.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 4","pages":"Article 101078"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Management of Bleeding Ectopic Varices","authors":"Mario Dervishi MD,&nbsp;Alex Stevens DO,&nbsp;Christopher Sutter MD,&nbsp;Ignacio Chiong MD,&nbsp;Jon Davidson MD, FSIR","doi":"10.1016/j.tvir.2025.101080","DOIUrl":"10.1016/j.tvir.2025.101080","url":null,"abstract":"<div><div>Ectopic varices are dilated nongastroesophageal mesoportal veins that occur due to hepatic portal hypertension, portomesenteric occlusion, or prior abdominal surgeries, with less common causes including congenital conditions. These varices can occur in various locations, including the duodenum, jejunum, large bowel, and biliary system, and can lead to clinically significant gastrointestinal hemorrhages warranting intervention. An understanding of ectopic variceal anatomy and the etiology of variceal bleeding is imperative to optimal treatment. Despite a lack of standardized treatment guidelines, endovascular management remains vital for controlling bleeding and improving patient outcomes.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 4","pages":"Article 101080"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Portal Vein Thrombosis: Diagnosis, Management, and Review of the Literature","authors":"Wei Lue Tong MD ,&nbsp;Sameer Gadani MD, FSIR","doi":"10.1016/j.tvir.2025.101084","DOIUrl":"10.1016/j.tvir.2025.101084","url":null,"abstract":"<div><div>Chronic portal vein thrombosis (PVT) is a challenging condition to diagnose and manage due to the presence of complex, concomitant comorbidities and rapidly evolving clinical evidence. The purpose of this article is to review the clinical presentation, guidelines and evidence supporting invasive and noninvasive management strategies for PVT, including information about the technical evolution and outcomes for portal venous recanalization (PVR) with transjugular intrahepatic portosystemic shunt (TIPS) creation (PVR-TIPS), particularly in the setting of newly available literature and guidelines. Additionally, we describe our technique for PVR-TIPS.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 4","pages":"Article 101084"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}