Journal of Clinical Medicine

Editorial

Jump to: Research, Review, Other

4 pages, 183 KiB

Open AccessEditorial

Editorial of Special Issue “Embolization Techniques: State of the Art and Future Perspectives”

by Massimo Venturini, Filippo Piacentino, Andrea Coppola and Federico Fontana

J. Clin. Med. 2022, 11(17), 5109; https://doi.org/10.3390/jcm11175109 - 30 Aug 2022

Cited by 1 | Viewed by 1273

Abstract

Embolization is one of the most important applications in interventional radiology which can be mainly performed using an endovascular approach [...] Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

Research

Jump to: Editorial, Review, Other

13 pages, 3271 KiB

Open AccessArticle

Pulmonary Artery Pseudoaneurysms Embolization: Bicentric Experience and Review of the Literature

by Federico Fontana, Filippo Piacentino, Marco Curti, Anna Maria Ierardi, Andrea Coppola, Edoardo Macchi, Giuseppe De Marchi, Eliodoro Faiella, Domiziana Santucci, Lorenzo Paolo Moramarco, Filippo Del Grande, Gabriele Piffaretti, Matteo Tozzi, Andrea Imperatori, Giulio Carcano, Antonio Basile, Fabio D’Angelo, Gianpaolo Carrafiello and Massimo Venturini

J. Clin. Med. 2023, 12(11), 3796; https://doi.org/10.3390/jcm12113796 - 31 May 2023

Cited by 3 | Viewed by 1968

Abstract

The purpose of this bicentric case series was to report the safety, efficacy, and clinical outcome of transcatheter embolization in pulmonary artery pseudoaneurysms (PAPAs). Between January 2016 and June 2021, eight patients with PAPA were subjected to transcatheter embolization. The total number of [...] Read more.

The purpose of this bicentric case series was to report the safety, efficacy, and clinical outcome of transcatheter embolization in pulmonary artery pseudoaneurysms (PAPAs). Between January 2016 and June 2021, eight patients with PAPA were subjected to transcatheter embolization. The total number of patients was eight, of which five were female, with a mean age of 62 ± 14 years (average ± standard deviation). Etiology was traumatic in 2/8 cases and iatrogenic in 6/8 cases (after positioning a Swan-Ganz catheter in 5/6 cases and a temporary pacemaker in the latter case). In a single case, the PAPA was incidentally discovered during a routine X-ray, in the remaining 7 cases, the procedure was performed in emergency settings. PAPA embolization was performed using detachable coils alone in 3 cases; coils and glue in 1 case; coils, glue, and vascular plug in 1 case; coils and non-adhesive liquid embolic agents (Onyx and Squid respectively) in 2 cases; and non-adhesive liquid embolic agent alone (Onyx) in 1 case. No peri-procedural or post-procedural complications were recorded. Both the technical and clinical success rates were 100.0%. In conclusion, endovascular embolization is a technically feasible and safe therapeutic option for patients with PAPAs. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

10 pages, 3085 KiB

Open AccessArticle

Transvenous Pulmonary Chemoembolization and Optional Microwave Ablation for Colorectal Lung Metastases

by Thomas J. Vogl, Lars Hammann and Hamzah Adwan

J. Clin. Med. 2023, 12(10), 3394; https://doi.org/10.3390/jcm12103394 - 10 May 2023

Cited by 1 | Viewed by 1528

Abstract

(1) Purpose: To evaluate tumor response and survival of patients with colorectal pulmonary metastases treated by transvenous pulmonary chemoembolization (TPCE) alone with palliative intent or TPCE followed by microwave ablation (MWA) with potentially curative intent. (2) Material and methods: A total of 164 [...] Read more.

(1) Purpose: To evaluate tumor response and survival of patients with colorectal pulmonary metastases treated by transvenous pulmonary chemoembolization (TPCE) alone with palliative intent or TPCE followed by microwave ablation (MWA) with potentially curative intent. (2) Material and methods: A total of 164 patients (64 women and 100 men; mean age: 61.8 ± 12.7 years) with unresectable colorectal lung metastases and not responding to systemic chemotherapy, who either received repetitive TPCE (Group A) or TPCE followed by MWA (Group B), were retrospectively enrolled. The revised response evaluation criteria in solid tumors were used to assess treatment response in Group A. The oncological response in Group B was divided into local tumor progression (LTP) and intrapulmonary distant recurrence (IDR) after MWA. (3) Results: The 1-, 2-, 3-, and 4-year survival rates were 70.4%, 41.4%, 22.3%, and 5%, respectively, for all patients. In Group A; the rates of stable disease; progressive disease; and partial response were at 55.4%, 41.9%, and 2.7%, respectively. The rates of LTP and IDR were 3.8%, and 63.5%, respectively, in Group B. Conclusion: TPCE is an effective treatment for colorectal lung metastases, which can be performed alone or combined with MWA. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

12 pages, 647 KiB

Open AccessFeature PaperArticle

Improved Survival after Transarterial Radioembolisation for Hepatocellular Carcinoma Gives the Procedure Added Value

by Cristina Mosconi, Alberta Cappelli, Cinzia Pettinato, Maria Adriana Cocozza, Giulio Vara, Eleonora Terzi, Maria Cristina Morelli, Elisa Lodi Rizzini, Matteo Renzulli, Francesco Modestino, Matteo Serenari, Rachele Bonfiglioli, Letizia Calderoni, Elena Tabacchi, Matteo Cescon, Alessio Giuseppe Morganti, Franco Trevisani, Fabio Piscaglia, Stefano Fanti, Lidia Strigari, Alessandro Cucchetti and Rita Golfieri Show full author list Hide full author list

J. Clin. Med. 2022, 11(24), 7469; https://doi.org/10.3390/jcm11247469 - 16 Dec 2022

Cited by 5 | Viewed by 1545

Abstract

Background: Transarterial Radioembolisation (TARE) requires multidisciplinary experience and skill to be effective. The aim of this study was to identify determinants of survival in patients with hepatocellular carcinoma (HCC), focusing on learning curves, technical advancements, patient selection and subsequent therapies. Methods: From 2005 [...] Read more.

Background: Transarterial Radioembolisation (TARE) requires multidisciplinary experience and skill to be effective. The aim of this study was to identify determinants of survival in patients with hepatocellular carcinoma (HCC), focusing on learning curves, technical advancements, patient selection and subsequent therapies. Methods: From 2005 to 2020, 253 patients were treated. TARE results achieved in an initial period (2005–2011) were compared to those obtained in a more recent period (2012–2020). To isolate the effect of the treatment period, differences between the two periods were balanced using “entropy balance”. Results: Of the 253 patients, 68 were treated before 2012 and 185 after 2012. In the second period, patients had an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) score of 1 (p = 0.025) less frequently, less liver involvement (p = 0.006) and a lesser degree of vascular invasion (p = 0.019). The median overall survival (OS) of patients treated before 2012 was 11.2 months and that of patients treated beginning in 2012 was 25.7 months. After reweighting to isolate the effect of the treatment period, the median OS of patients before 2012 increased to 16 months. Conclusions: Better patient selection, refinement of technique and adoption of personalised dosimetry improved survival after TARE. Conversely, sorafenib after TARE did not impact life expectancy. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

9 pages, 3327 KiB

Open AccessArticle

Internal Iliac Artery Embolization within EVAR Procedure: Safety, Feasibility, and Outcome

by Federico Fontana, Andrea Coppola, Lucrezia Ferrario, Giuseppe De Marchi, Edoardo Macchi, Giada Zorzetto, Marco Franchin, Gabriele Piffaretti, Matteo Tozzi, Giulio Carcano, Filippo Piacentino and Massimo Venturini

J. Clin. Med. 2022, 11(24), 7399; https://doi.org/10.3390/jcm11247399 - 14 Dec 2022

Cited by 3 | Viewed by 1571

Abstract

Background: This study is focused on Internal Iliac Artery (IIA) embolization in patients undergoing Endovascular Aneurysm Repair (EVAR). Our aims were: to establish the feasibility of the procedure; to assess the presence of endoleak (EL) and increase in the size of the sac [...] Read more.

Background: This study is focused on Internal Iliac Artery (IIA) embolization in patients undergoing Endovascular Aneurysm Repair (EVAR). Our aims were: to establish the feasibility of the procedure; to assess the presence of endoleak (EL) and increase in the size of the sac at follow-up; to define the need for reintervention; and to evaluate mortality rate. Methods: In this retrospective single-center study, EVAR-treated patients with an embolization of IIA were chosen. Coils and vascular plug were used as embolizing agents. Results: A total of 49 participants were enrolled in the study (48 men and one woman) with a median age of 76 ± 12 years. Patients had no early EL in 87.75% of cases, 8.16% had type 1a EL, 2.04% type 1b EL, and 2.04% type 2 EL, with a comprehensive technical success of 95.91%. In the follow-up, at 1 month 72.22% remained without EL, at 6 months 70.97%, and at 1 year 81.48%. In the same period, the trend of type 1 EL was 5.56% (1 month), 3.23% (6 months), and 0% (1 year). For EL type 2: 22.22% at 1 month, 25.81% at 6 months, and 16.7% at 1 year. The overall mortality was 35.58% and the re-intervention rate was 16.33%. Conclusions: IIA embolization is a feasible and safe procedure. The presence of EL is not superior to EVAR procedures that do not involve embolization. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

10 pages, 1551 KiB

Open AccessArticle

The Role of Immediate Post-Procedural Cone-Beam Computed Tomography (CBCT) in Predicting the Early Radiologic Response of Hepatocellular Carcinoma (HCC) Nodules to Drug-Eluting Bead Transarterial Chemoembolization (DEB-TACE)

by Marco Fronda, Francesco Mistretta, Marco Calandri, Fernanda Ciferri, Floriana Nardelli, Laura Bergamasco, Paolo Fonio and Andrea Doriguzzi Breatta

J. Clin. Med. 2022, 11(23), 7089; https://doi.org/10.3390/jcm11237089 - 29 Nov 2022

Cited by 7 | Viewed by 1730

Abstract

The purpose of this study was to evaluate the efficacy of unenhanced cone-beam computed tomography (CBCT) performed at the end of drug-eluting bead transarterial chemoembolization (DEB-TACE) in predicting HCC nodules’ early radiologic response to treatment, assessed using mRECIST criteria with a 30–60 day [...] Read more.

The purpose of this study was to evaluate the efficacy of unenhanced cone-beam computed tomography (CBCT) performed at the end of drug-eluting bead transarterial chemoembolization (DEB-TACE) in predicting HCC nodules’ early radiologic response to treatment, assessed using mRECIST criteria with a 30–60 day four-phase contrast-enhanced CT follow-up. Fifty-nine patients (81 lesions) subjected to DEB-TACE as exclusive treatment for HCC lesions (naive/relapse) between February 2020 and October 2021 were prospectively enrolled. In a post-interventional unenhanced CBCT procedure, two experienced radiologists evaluated for each lesion the overall intensity of the contrast media deposit, the homogeneity of the enhancement, and the presence of smooth and complete margins. The univariate analysis found that lesions with complete response (CR+) had a significantly higher incidence of clear and complete margins than CR− lesions (76.9% vs. 17.2%, p = 0.003) and a higher intensity score (67.3% vs. 27.6%, p = 0.0009). A Dmax <30 mm was significantly more common among CR+ than CR− lesions (92.3% vs. 69%, p = 0.01). These features were confirmed as significant predictors for CR+ by multivariate binary logistic regression. The homogeneity of the enhancement did not affect the DEB-TACE outcome. Post-interventional unenhanced CBCT is effective in predicting early radiological response to DEB-TACE, since the presence of an intense contrast media deposit with clear and complete margins in treated HCC lesions is associated with CR. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

8 pages, 903 KiB

Open AccessArticle

Comaneci-Assisted Coiling of Wide-Necked Intracranial Aneurysm: A Single-Center Preliminary Experience

by Gabriele Vinacci, Angelica Celentano, Edoardo Agosti, Alberto Vito Terrana, Francesco Alberto Vizzari, Luca Nativo, Fabio Baruzzi, Antonio Tabano, Davide Locatelli and Andrea Giorgianni

J. Clin. Med. 2022, 11(22), 6650; https://doi.org/10.3390/jcm11226650 - 9 Nov 2022

Cited by 3 | Viewed by 1667

Abstract

Background: Wide-necked aneurysms remain challenging for both coiling and microsurgical clipping. They often require additional techniques to prevent coil prolapse into the parent artery, such as balloon- and stent-assisted coiling. Comaneci is an expandable and removable stent that acts as a bridging device [...] Read more.

Background: Wide-necked aneurysms remain challenging for both coiling and microsurgical clipping. They often require additional techniques to prevent coil prolapse into the parent artery, such as balloon- and stent-assisted coiling. Comaneci is an expandable and removable stent that acts as a bridging device and does not interfere with the blood flow of the parent artery. Methods: We retrospectively reviewed our institutional radiological and clinical chart of patients treated for saccular intracranial aneurysm via endovascular Comaneci-assisted coiling. The aim of the study was to report our preliminary experience in Comaneci-assisted coiling of wide-necked intracranial aneurysms. Results: We included 14 patients in the study. Of these, 11 had a ruptured intracranial aneurysm and were treated with Comaneci-assisted coiling. We registered five minor intraprocedural complications and two intraprocedural failures of the device. At one-year follow-up, a satisfying aneurysm occlusion was observed in 85% of the cases. Conclusions: Though long-term follow-up data and larger case series are needed, this preliminary study showed the feasibility of the Comaneci-assisted coiling method for both ruptured and unruptured wide-neck intracranial aneurysms, with similar occlusion rates as balloon-assisted coiling. However, we registered high incidence of thromboembolic complications; these were probably related to the lack of heparin administration. The main advantageous application of this technique is likely in cases of ruptured intracranial aneurysms, as there is no need for post-procedural antiplatelet therapy. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

11 pages, 1346 KiB

Open AccessArticle

Role of Bronchial Artery Embolization as Early Treatment Option in Stable Cystic Fibrosis Patients with Sub-Massive Hemoptysis: Personal Experience and Literature Review

by Chiara Floridi, Pietro Boscarato, Claudio Ventura, Alessandra Bruno, Nicolo’ Rossini, Michela Baldassari, Cecilia Lanza, Benedetta Fabrizzi, Roberto Candelari and Andrea Giovagnoni

J. Clin. Med. 2022, 11(21), 6432; https://doi.org/10.3390/jcm11216432 - 30 Oct 2022

Cited by 4 | Viewed by 2472

Abstract

(1) Background: We describe our experience with cystic fibrosis (CF) patients treated with bronchial artery embolization (BAE) for sub-massive hemoptysis to understand if early treatment of sub-massive hemoptysis can reduce the volume of any subsequent bleedings. (2) Materials: We performed a retrospective study [...] Read more.

(1) Background: We describe our experience with cystic fibrosis (CF) patients treated with bronchial artery embolization (BAE) for sub-massive hemoptysis to understand if early treatment of sub-massive hemoptysis can reduce the volume of any subsequent bleedings. (2) Materials: We performed a retrospective study including CF patients who underwent angiographic procedures for BAE following sub-massive hemoptysis, from March 2016 to December 2021. All patients underwent an initial chest angio-CT study. BAE was realized with microspheres or coils. (3) Results: Thirteen patients were included, subjected to at least one BAE after sub-massive hemoptysis, for a total of 19 procedures. Technical success was 94.7%; in a single case, the catheterization of the bronchial arterial feeder was not achievable and the procedure was repeated. Primary clinical success was 92.3%; secondary clinical success was 69.2%. Relative clinical success was 85%. A higher incidence of recurrent hemoptysis following treatment with coils was observed (100% of cases) compared to treatment with microspheres (54.5% of cases) χ² = 5.43 (p < 0.05). (4) Conclusions: BAE is a safe and effective method for the treatment of hemoptysis in CF patients; it should be practiced not only after massive or recurrent hemoptysis but also in patients with sub-massive bleeding to improve their life expectancy and quality of life. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

8 pages, 399 KiB

Open AccessArticle

Woven EndoBridge in Wide-Neck Bifurcation Aneurysms: Digital Subtraction Angiography at 3-Year Follow-Up

by Carmelo Stanca, Serena Carriero, Davide Negroni, Marco Spinetta, Carolina Coda, Pierpaolo Biondetti and Giuseppe Guzzardi

J. Clin. Med. 2022, 11(10), 2879; https://doi.org/10.3390/jcm11102879 - 19 May 2022

Cited by 4 | Viewed by 1707

Abstract

Introduction: The Woven EndoBridge (WEB) device is a self-expanding intrasaccular braided-wire device for the treatment of wide-neck bifurcation aneurysms (WNBAs). Even though this device has an excellent safety profile and a low risk of rebleeding, little is known about its long-term effects. Material [...] Read more.

Introduction: The Woven EndoBridge (WEB) device is a self-expanding intrasaccular braided-wire device for the treatment of wide-neck bifurcation aneurysms (WNBAs). Even though this device has an excellent safety profile and a low risk of rebleeding, little is known about its long-term effects. Material and Methods: All patients treated with WEB due to ruptured WNBAs were subjected to follow-up digital subtraction angiography (DSA) at 2 and 3 years after device deployment. The degree of residual neck was assessed through BOSS, Lubicz, and WEBCAST scales. Data on modified Rankin scale (mRS), bleeding events, and ischemic events occurring during this time period were collected as well. Lastly, overall and procedure-related mortality rates were calculated. Results: A total of 21 patients were treated between 1 January 2016, and 31 December 2018. DSA demonstrated a patency grade of 57.1% and 61.1% at 2 and 3 years, respectively. The overall 2-year mortality rate due to causes unrelated to the aneurysm was 14.3%. None of the patients were retreated between the 2- and the 3-year follow-up. No rebleeding or stroke events occurred during the follow-up. Conclusions: WEB-treated ruptured aneurysms showed an excellent degree of stability over time. The overall mortality rate—unrelated to the procedure–observed in our sample was higher than what reported in the literature, a possible bias associated with the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

15 pages, 3528 KiB

Open AccessArticle

Selective Arterial Embolization with N-Butyl Cyanoacrylate Prior to CT-Guided Percutaneous Cryoablation of Kidney Malignancies: A Single-Center Experience

by Olivier Lopez, Olivier Chevallier, Kévin Guillen, Pierre-Olivier Comby, Julie Pellegrinelli, Claire Tinel, Nicolas Falvo, Marco Midulla, Eric Mourey and Romaric Loffroy

J. Clin. Med. 2021, 10(21), 4986; https://doi.org/10.3390/jcm10214986 - 27 Oct 2021

Cited by 3 | Viewed by 2408

Abstract

The study’s purpose was to assess the safety, feasibility and efficiency of selective arterial embolization (SAE) using N-butyl cyanoacrylate (NBCA) glue before percutaneous cryoablation (PCA) of renal malignancies in patients whose tumor characteristics and/or comorbidities resulted in an unacceptable risk of bleeding. In [...] Read more.

The study’s purpose was to assess the safety, feasibility and efficiency of selective arterial embolization (SAE) using N-butyl cyanoacrylate (NBCA) glue before percutaneous cryoablation (PCA) of renal malignancies in patients whose tumor characteristics and/or comorbidities resulted in an unacceptable risk of bleeding. In this single-center retrospective study of 19 consecutive high-risk patients (median age, 74 years) with renal malignancies managed in 2017–2020 by SAE with NBCA followed by PCA, data about patients, tumor and procedures characteristics, complications, renal function and hemoglobin concentration before and after treatment, as well as recurrence were collected. Charlson comorbidity index was ≥4 in 89.5% of patients. Ten patients were treated by antiplatelet and/or anticoagulant therapy. Median tumor largest diameter was 3.75 cm (range, 1–6.5 cm) and R.E.N.A.L. nephrometry score was ≥7 in 80%, indicating substantial tumor complexity. No major complications were recorded and minor complications occurred in 7 patients. No residual tumor was found at 6-week imaging follow-up in 18/19 patients. Tumor recurrence was visible in 1/16 patients at 6-month imaging follow-up. No significant difference was found for renal function after treatment (p = 0.07), whereas significant decrease in hemoglobin concentration was noted (p = 0.00004), although it was relevant for only one patient who required only blood transfusion and no further intervention. SAE prior to PCA is safe and effective for managing renal malignancies in high-risk patients. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

16 pages, 1678 KiB

Open AccessArticle

Short- and Long-Term Safety and Efficacy of Self-Expandable Leo Stents Used Alone or with Coiling for Ruptured and Unruptured Intracranial Aneurysms: A Retrospective Observational Study

by François Lebeaupin, Pierre-Olivier Comby, Marc Lenfant, Pierre Thouant, Brivaël Lemogne, Kévin Guillen, Olivier Chevallier, Frédéric Ricolfi and Romaric Loffroy

J. Clin. Med. 2021, 10(19), 4541; https://doi.org/10.3390/jcm10194541 - 30 Sep 2021

Cited by 4 | Viewed by 2733

Abstract

To assess the efficacy and safety of the Leo stent used alone or with coiling to treat complex intracranial aneurysms (IAs) not eligible for simple or balloon-assisted coiling, this single-center retrospective study included consecutive adults with ruptured or unruptured IAs treated in 2011–2018 [...] Read more.

To assess the efficacy and safety of the Leo stent used alone or with coiling to treat complex intracranial aneurysms (IAs) not eligible for simple or balloon-assisted coiling, this single-center retrospective study included consecutive adults with ruptured or unruptured IAs treated in 2011–2018 by stenting with or without coiling. The indication for stenting was IA complexity precluding simple or balloon-assisted coiling. Extensive data on the patients, IAs, antiplatelet treatments, procedures, and outcomes over the first 36 months were collected. Risk factors for early complications (univariate analysis) and delayed ischemia (multivariate analysis) were sought. We include 64 patients with 66 IAs. The procedural success rate was 65/66 (98.5%). Obliteration was Raymond Roy class I or II for 85% of IAs. Six patients died including four of the 12 patients presenting with subarachnoid hemorrhage, which was the only significant risk factor for early major complications. At 1 month, 45/64 (69%) had no disabilities. No rebleeding was reported. Ischemia was detected by routine MRI in 20 (35%) of the 57 patients with long-term data and was asymptomatic in 14. The stent-within-a-stent configuration was the only independent risk factor for ischemia. The Leo stent used alone or with coils to manage challenging IAs was associated with a high procedural success rate and complete or nearly complete IA obliteration of 85% of IAs. The high frequency of ischemia is ascribable to our use of routine serial MRI. In patients with bleeding, the Leo stent was associated with an excess risk of early, major, intracranial complications, as compared to patients without bleeding. Long-term follow-up was marked by the occurrence of ischemic events in the vascular territory of the stent, mostly silent. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

11 pages, 992 KiB

Open AccessArticle

Management of Liver Tumors during the COVID-19 Pandemic: The Added Value of Selective Internal Radiation Therapy (SIRT)

by Irene Bargellini, Giuseppe Boni, Antonio Claudio Traino, Elena Bozzi, Giulia Lorenzoni, Francesca Bianchi, Rosa Cervelli, Tommaso Depalo, Laura Crocetti, Duccio Volterrani and Roberto Cioni

J. Clin. Med. 2021, 10(19), 4315; https://doi.org/10.3390/jcm10194315 - 22 Sep 2021

Cited by 5 | Viewed by 2155

Abstract

Background: In the context of the coronavirus disease 2019 (COVID-19) pandemic, liver-directed therapies (LDTs) may offer minimally invasive integrative tools for tumor control. Among them, selective internal radiation therapy (SIRT) represents a safe, flexible and effective treatment. Purpose of this study is to [...] Read more.

Background: In the context of the coronavirus disease 2019 (COVID-19) pandemic, liver-directed therapies (LDTs) may offer minimally invasive integrative tools for tumor control. Among them, selective internal radiation therapy (SIRT) represents a safe, flexible and effective treatment. Purpose of this study is to present our experience with SIRT during the first wave of COVID-19 pandemic and provide an overview of the indications and challenges of SIRT in this scenario. Methods: We retrospectively analyzed the number of patients evaluated by Multidisciplinary Liver Tumor Board (MLTB) and who were undergoing LDTs between March and July 2020 and compared it with 2019. For patients treated with SIRT, clinical data, treatment details and the best radiological response were collected. Results: Compared to 2019, we observed a 27.5% reduction in the number of patients referred to MLTB and a 28.3% decrease in percutaneous ablations; transarterial chemoembolizations were stable, while SIRT increased by 64%. The majority of SIRT patients (75%) had primary tumors, mostly HCC. The best objective response and disease control rates were 56.7% and 72.2%, respectively. Conclusion: The first wave of the COVID-19 pandemic was characterized by an increased demand for SIRT, which represents a safe, flexible and effective treatment, whose manageability will further improve by simplifying the treatment workflow, developing user-friendly and reliable tools for personalized dosimetry and improving interdisciplinary communication. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

12 pages, 1802 KiB

Open AccessArticle

Selective Arterial Embolization of Renal Angiomyolipomas with a N-Butyl Cyanoacrylate-Lipiodol Mixture: Efficacy, Safety, Short- and Mid-Term Outcomes

by François-Victor Prigent, Kévin Guillen, Pierre-Olivier Comby, Julie Pellegrinelli, Nicolas Falvo, Marco Midulla, Nabil Majbri, Olivier Chevallier and Romaric Loffroy

J. Clin. Med. 2021, 10(18), 4062; https://doi.org/10.3390/jcm10184062 - 8 Sep 2021

Cited by 11 | Viewed by 3798

Abstract

Selective arterial embolization (SAE) for renal angiomyolipoma (rAML) is effective to treat or prevent bleeding. We report our experience using a cyanoacrylate–Lipiodol mixture. We performed a single-center retrospective review of all rAMLs embolized with cyanoacrylate glue between July 2014 and June 2020. Demographics, [...] Read more.

Selective arterial embolization (SAE) for renal angiomyolipoma (rAML) is effective to treat or prevent bleeding. We report our experience using a cyanoacrylate–Lipiodol mixture. We performed a single-center retrospective review of all rAMLs embolized with cyanoacrylate glue between July 2014 and June 2020. Demographics, tuberous sclerosis complex (TSC) status, clinical presentation, angiography features, and follow-up data were recorded. Pre- and post-procedure rAML sizes and volumes were estimated from computed tomography (CT) or magnetic resonance imaging (MRI) studies. Kidney function was assessed before and after the procedure. We identified 24 patients (22 females and 2 males, mean age 51 years) treated for 27 AMLs, either prophylactically (n = 20) or as an emergency (n = 4). Technical success was achieved for 25/27 AMLs; two patients, each with a single AML, required nephrectomy and repeated embolization, respectively. Major complications occurred in three patients and minor complications such as postembolization syndrome in 15 patients. AML volume reduction after embolization was 55.1% after a mean follow-up of 15 months (range, 1–72 months). Factors associated with greater volume reduction were a smaller percentage of fat (p = 0.001), larger initial rAML volume (p = 0.014), and longer follow-up (p = 0.0001). The mean creatinine level did not change after SAE. Embolization of rAMLs with a mixture of cyanoacrylate and Lipiodol is feasible, safe, and effective in significantly decreasing tumor volume. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

10 pages, 2341 KiB

Open AccessArticle

Twenty Years of Experience in Juvenile Nasopharyngeal Angiofibroma (JNA) Preoperative Endovascular Embolization: An Effective Procedure with a Low Complications Rate

by Andrea Giorgianni, Stefano Molinaro, Edoardo Agosti, Alberto Vito Terrana, Francesco Alberto Vizzari, Alberto Daniele Arosio, Giacomo Pietrobon, Luca Volpi, Mario Turri-Zanoni, Giuseppe Craparo, Filippo Piacentino, Paolo Castelnuovo, Fabio Massimo Baruzzi and Maurizio Bignami

J. Clin. Med. 2021, 10(17), 3926; https://doi.org/10.3390/jcm10173926 - 31 Aug 2021

Cited by 11 | Viewed by 4923

Abstract

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical [...] Read more.

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical complications. In our series of 79 patients who underwent preoperative embolization from 1999 to 2020, demographics, procedural aspects, surgical management and follow-up outcome were analyzed. Embolization was performed in a similar fashion for all patients, with a superselective microcatheterization of external carotid artery (ECA) feeders and an injection of polyvinyl alcohol (PVA) particles, followed, in some cases, by the deployment of coils . Procedural success was reached in 100% of cases, with no complications such as bleeding or thromboembolic occlusion, and surgical intraoperative blood loss was significantly decreased. In conclusion, PIAE is a safe and effective technique in JNA treatment, minimizing intraoperative bleeding. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

14 pages, 2250 KiB

Open AccessArticle

Prostate Artery Embolization Using N-Butyl Cyanoacrylate Glue for Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Valid Alternative to Microparticles?

by Romaric Loffroy, Kévin Guillen, Etienne Salet, Clément Marcelin, Pierre-Olivier Comby, Marco Midulla, Nicolas Grenier, Olivier Chevallier and François Petitpierre

J. Clin. Med. 2021, 10(14), 3161; https://doi.org/10.3390/jcm10143161 - 17 Jul 2021

Cited by 20 | Viewed by 3291

Abstract

Our goal was to evaluate the feasibility, safety, and short-term outcomes of prostate artery embolization (PAE) with N-butyl cyanoacrylate (NBCA) glue as the only embolic agent in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTSs). A two-center retrospective study of [...] Read more.

Our goal was to evaluate the feasibility, safety, and short-term outcomes of prostate artery embolization (PAE) with N-butyl cyanoacrylate (NBCA) glue as the only embolic agent in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTSs). A two-center retrospective study of 50 patients (mean age, 67.6 ± 7.4 years; range, 54–85 years) treated with NBCA between 2017 and 2020 was conducted. PAE was performed using a mixture of Glubran 2 glue and Lipiodol in a 1:8 ratio, under local anesthesia, on an outpatient basis, after cone-beam computed tomography vascular mapping. Mean total injected NBCA/Lipiodol volume was 0.9 ± 0.3 mL, total injection time was 21.9 ± 7.8 s, and total radiation dose was 18,458 ± 16,397 mGy·cm. Statistically significant improvements over time occurred for the International Prostate Symptoms Score (9.9 ± 6.8 versus 20.5 ± 6.7, p = 0.0001), quality-of-life score (2.2 ± 1.5 versus 4.9 ± 1.0, p = 0.0001), prostate-specific antigen level (4.6 ± 3.0 versus 6.4 ± 3.7, p = 0.0001), and prostate volume (77.3 ± 30.5 versus 98.3 ± 40.2, p = 0.0001) at a median of 3 months versus baseline. Minor adverse events developed in 11/50 (22%) patients, but no major complications occurred. The International Index of Erectile Function did not change significantly. PAE with NBCA is feasible, safe, fast, and effective for patients with BPH-related LUTSs. Prospective comparative studies with longer follow-ups are warranted. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

8 pages, 1499 KiB

Open AccessArticle

Use of Phil Embolic Agent for Bleeding in Non-Neurological Interventions

by Pierleone Lucatelli, Mario Corona, Leonardo Teodoli, Piergiorgio Nardis, Alessandro Cannavale, Bianca Rocco, Claudio Trobiani, Stefano Cipollari, Simone Zilahi de Gyurgyokai, Mario Bezzi and Carlo Catalano

J. Clin. Med. 2021, 10(4), 701; https://doi.org/10.3390/jcm10040701 - 11 Feb 2021

Cited by 13 | Viewed by 2544

Abstract

Objective: To evaluate the safety and efficacy of the Phil liquid embolic agent in non-neurological embolization procedures. M&M: Thirty-five patients with a mean age of 62.5 years underwent percutaneous embolization using Phil for the treatment of visceral arterial bleedings in 20/35 patients (including [...] Read more.

Objective: To evaluate the safety and efficacy of the Phil liquid embolic agent in non-neurological embolization procedures. M&M: Thirty-five patients with a mean age of 62.5 years underwent percutaneous embolization using Phil for the treatment of visceral arterial bleedings in 20/35 patients (including three gluteal, one bladder, two superior mesenteric, three epigastric, one deep femoral, five internal iliac, four intercostal, and one lingual arteries), splanchnic pseudoaneurysms in 11/35 patients (including three hepatic, five splenic, and three renal arteries), pancreatic bleeding metastasis in 1/35 patient, and gastric bleeding varices in 3/35 patients. Phil is composed of a non-adhesive copolymer dissolved in DMSO (Anhydrous Dimethyl Sulfoxide) with different viscosity. Procedures were performed slowly under continuous fluoroscopic guidance to avoid embolization of non-target vessels. Results: Clinical success was obtained with a single intervention in 34 cases (97.15%), while a repeated procedure was required in one case (2.85%). No technical complications nor non-target embolization occurred. A case of post-embolic syndrome was noted (2.85%) in one patient. DMSO administration-related pain was successfully controlled by medical therapy. Conclusion: Phil can be considered a safe and effective embolic agent for the treatment of non-neurologic bleeding. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

11 pages, 2693 KiB

Open AccessArticle

Packing Technique with or without Remodeling for Endovascular Coil Embolization of Renal Artery Aneurysms: Safety, Efficacy and Mid-Term Outcomes

by Grégory Secco, Olivier Chevallier, Nicolas Falvo, Kévin Guillen, Pierre-Olivier Comby, Christiane Mousson, Nabil Majbri, Marco Midulla and Romaric Loffroy

J. Clin. Med. 2021, 10(2), 326; https://doi.org/10.3390/jcm10020326 - 17 Jan 2021

Cited by 6 | Viewed by 2805

Abstract

The endovascular treatment of renal artery aneurysms (RAAs) has lower morbidity and shorter stay lengths compared to surgical repair. Here, we describe coil packing with or without remodeling and assess outcomes and complications. We retrospectively identified the 19 consecutive preventive endovascular RAA coil [...] Read more.

The endovascular treatment of renal artery aneurysms (RAAs) has lower morbidity and shorter stay lengths compared to surgical repair. Here, we describe coil packing with or without remodeling and assess outcomes and complications. We retrospectively identified the 19 consecutive preventive endovascular RAA coil embolizations done in 18 patients at our center in 2010–2020. Patient and aneurysm characteristics, technical success rate, complications, and recurrences were recorded. Mean patient age was 63 ± 13 years. The RAA was >1.5 cm in 11 cases, and in four cases, the aneurysm-to-parent artery size ratio was >2. Simple coiling was performed for 11 (57.9%) aneurysms, stent-assisted coiling for seven (36.8%) aneurysms, and balloon-assisted coiling for one (5.3%) aneurysm. Technical success rate was 100%. Complete definitive RAA exclusion was achieved with a single procedure for 17 (89.5%) aneurysms, whereas two (10.5%) aneurysms required a repeat procedure. Four minor complications occurred but resolved with no long-term consequences. No major complications occurred during the mean follow-up of 41.1 ± 29.7 months. Coil embolization by sac packing or remodeling proved very safe and effective. Together with the known lower morbidity and shorter stay length compared to open surgery, these data indicate that this endovascular procedure should become the preventive treatment of choice for RAAs. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

10 pages, 958 KiB

Open AccessArticle

Side Effect/Complication Risk Related to Injection Branch Level of Chemoembolization in Treatment of Metastatic Liver Lesions from Colorectal Cancer

by Marcin Szemitko, Elzbieta Golubinska-Szemitko, Ewa Wilk-Milczarek and Aleksander Falkowski

J. Clin. Med. 2021, 10(1), 121; https://doi.org/10.3390/jcm10010121 - 31 Dec 2020

Cited by 8 | Viewed by 2309

Abstract

Purpose: Transarterial chemoembolization with drug eluting beads (DEB-TACE) loaded with irinotecan despite having proven efficacy in the treatment of unresectable liver metastases in the course of colorectal cancer (CRC) does not have an established consistent method. In particular, there are discrepancies in the [...] Read more.

Purpose: Transarterial chemoembolization with drug eluting beads (DEB-TACE) loaded with irinotecan despite having proven efficacy in the treatment of unresectable liver metastases in the course of colorectal cancer (CRC) does not have an established consistent method. In particular, there are discrepancies in the branch level at which microspheres are administered. Lobar embolization supplies microspheres to all vessels supplying a metastatic lesion but exposes the entire liver parenchyma to negative effects from microsphere irinotecan. Superselective chemoembolization compromises healthy liver parenchyma less but may omit small vessels supplying metastatic lesions. Objective: Assessment of the risk of complications and the severity of postembolization syndromes with CRC metastatic liver lesion chemoembolization with irinotecan-loaded microspheres, according to branch level of chemoembolization. Patients and methods: The analysis included 49 patients (27 female/22 male) with liver metastases in the course of CRC, who underwent 192 chemoembolization treatments (mean 3.62 per patient) with microspheres loaded with 100 mg irinotecan. The procedures were performed according to an adopted schema: alternating the right and left lobe of the liver at 3-week intervals. The severity of postembolization syndrome (PES) and the presence of complications were assessed according to the branch level of chemoembolization; microspheres were administered at the branch level of lobar, segmental, or subsegmental arteries. Assessment of adverse events was performed according to the standards of the Cancer Therapy Evaluation Program Common Terminology Criteria for Adverse Events, Version 5.0. Results: The median survival of all patients from the start of chemoembolization was 13 months. With 192 chemoembolization sessions, 14 (7.3%) serious complications were found. The study showed no significant relationship between the branch level of embolizate administration and the presence of complications (p = 0.2307). Postembolization syndrome was diagnosed after 102 chemoembolization treatments, i.e., 53.1% of treatments. A significant correlation was found between the severity of the postembolization syndrome and the branch level of embolization treatment (p = 0.00303). The mean PES severity increased from subsegmental through segmental to lobar administration. Conclusion: Chemoembolization using Irinotecan-loaded microspheres was relatively well tolerated by patients and gave a low risk of significant complications, which did not change with the branch level of microsphere administration. However, an association was found between the branch level of chemoembolization and the severity of postembolization syndrome. Further research is needed to determine the most effective DEB-TACE chemoembolization technique. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

Review

Jump to: Editorial, Research, Other

15 pages, 3525 KiB

Open AccessReview

Interventional Radiological Management and Prevention of Complications after Pancreatic Surgery: Drainage, Embolization and Islet Auto-Transplantation

by Cristina Mosconi, Maria Adriana Cocozza, Filippo Piacentino, Federico Fontana, Alberta Cappelli, Francesco Modestino, Andrea Coppola, Diego Palumbo, Paolo Marra, Paola Maffi, Lorenzo Piemonti, Antonio Secchi, Claudio Ricci, Riccardo Casadei, Gianpaolo Balzano, Massimo Falconi, Giulio Carcano, Antonio Basile, Anna Maria Ierardi, Gianpaolo Carrafiello, Francesco De Cobelli, Rita Golfieri and Massimo Venturini Show full author list Hide full author list

J. Clin. Med. 2022, 11(20), 6005; https://doi.org/10.3390/jcm11206005 - 12 Oct 2022

Cited by 3 | Viewed by 2578

Abstract

Pancreatic surgery still remains burdened by high levels of morbidity and mortality with a relevant incidence of complications, even in high volume centers. This review highlights the interventional radiological management of complications after pancreatic surgery. The current literature regarding the percutaneous drainage of [...] Read more.

Pancreatic surgery still remains burdened by high levels of morbidity and mortality with a relevant incidence of complications, even in high volume centers. This review highlights the interventional radiological management of complications after pancreatic surgery. The current literature regarding the percutaneous drainage of fluid collections due to pancreatic fistulas, percutaneous transhepatic biliary drainage due to biliary leaks and transcatheter embolization (or stent–graft) due to arterial bleeding is analyzed. Moreover, also, percutaneous intra-portal islet auto-transplantation for the prevention of pancreatogenic diabetes in case of extended pancreatic resection is also examined. Moreover, a topic not usually treated in other similar reviewsas percutaneous intra-portal islet auto-transplantation for the prevention of pancreatogenic diabetes in case of extended pancreatic resection is also one of our areas of focus. In islet auto-transplantation, the patient is simultaneously donor and recipient. Differently from islet allo-transplantation, it does not require immunosuppression, has no risk of rejection and is usually efficient with a small number of transplanted islets. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

17 pages, 2466 KiB

Open AccessReview

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

by Filippo Piacentino, Federico Fontana, Marco Curti, Edoardo Macchi, Andrea Coppola, Christian Ossola, Andrea Giorgianni, Paolo Marra, Cristina Mosconi, Anna Maria Ierardi, Antonio Basile, Rita Golfieri, Gianpaolo Carrafiello, Giulio Carcano and Massimo Venturini

J. Clin. Med. 2021, 10(21), 4841; https://doi.org/10.3390/jcm10214841 - 21 Oct 2021

Cited by 18 | Viewed by 2765

Abstract

This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been [...] Read more.

This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been published recently and the aim of this review is to explore and analyze this field of application. There are a few NALEA liquids such as Onyx, Squid, and Phil currently available in the market, and they are used in the following applications: mainly arteriovenous malformations, endoleaks, visceral aneurysm or pseudoaneurysm, presurgical and hypervascular lesions embolization, and a niche of percutaneous approaches. These types of embolizing fluids can be used alone or in combination with other embolizing agents (such as coils or particles) so as to enhance its embolizing effect or improve its possible defects. The primary purpose of this paper is to evaluate the use of NALEAs, predominantly used alone, in elective embolization procedures. We did not attempt a meta-analysis due to the data heterogeneity, high number of case reports, and the lack of a consistent follow-up time period. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

19 pages, 6519 KiB

Open AccessReview

Endovascular Use of Cyanoacrylate-Lipiodol Mixture for Peripheral Embolization: Properties, Techniques, Pitfalls, and Applications

by Pierre-Olivier Comby, Kévin Guillen, Olivier Chevallier, Marc Lenfant, Julie Pellegrinelli, Nicolas Falvo, Marco Midulla and Romaric Loffroy

J. Clin. Med. 2021, 10(19), 4320; https://doi.org/10.3390/jcm10194320 - 23 Sep 2021

Cited by 24 | Viewed by 6454

Abstract

Endovascular embolization agents are particles and fluids that can be released into the bloodstream through a catheter to mechanically and/or biologically occlude a target vessel, either temporarily or permanently. Vascular embolization agents are available as solids, liquids, and suspensions. Although liquid adhesives (glues) [...] Read more.

Endovascular embolization agents are particles and fluids that can be released into the bloodstream through a catheter to mechanically and/or biologically occlude a target vessel, either temporarily or permanently. Vascular embolization agents are available as solids, liquids, and suspensions. Although liquid adhesives (glues) have been used as embolic agents for decades, experience with them for peripheral applications is generally limited. Cyanoacrylates are the main liquid adhesives used for endovascular interventions and have a major role in managing vascular abnormalities, bleeding, and many vascular diseases. They can only be injected as a mixture with ethiodized oil, which provides radiopacity and modulates the polymerization rate. This review describes the characteristics, properties, mechanisms of action, modalities of use, and indications of the cyanoacrylate-Lipiodol^® combination for peripheral embolization. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

8 pages, 1010 KiB

Open AccessReview

Hemorrhoids Embolization: State of the Art and Future Directions

by Alberto Rebonato, Daniele Maiettini, Alberto Patriti, Francesco Giurazza, Marcello Andrea Tipaldi, Filippo Piacentino, Federico Fontana, Antonio Basile and Massimo Venturini

J. Clin. Med. 2021, 10(16), 3537; https://doi.org/10.3390/jcm10163537 - 12 Aug 2021

Cited by 7 | Viewed by 4488

Abstract

Hemorrhoidal disease is a frustrating problem that has a relevant impact on patients’ psychological, social, and physical well-being. Recently, endovascular embolization of hemorrhoids has emerged as a promising mini-invasive solution with respect to surgical treatment. The purpose of this article is to review [...] Read more.

Hemorrhoidal disease is a frustrating problem that has a relevant impact on patients’ psychological, social, and physical well-being. Recently, endovascular embolization of hemorrhoids has emerged as a promising mini-invasive solution with respect to surgical treatment. The purpose of this article is to review the indications, technical aspects, clinical outcomes, and future prospective of endovascular embolization of symptomatic hemorrhoid patients. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

21 pages, 9740 KiB

Open AccessReview

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

by Massimo Venturini, Filippo Piacentino, Andrea Coppola, Valeria Bettoni, Edoardo Macchi, Giuseppe De Marchi, Marco Curti, Christian Ossola, Paolo Marra, Anna Palmisano, Alberta Cappelli, Antonio Basile, Rita Golfieri, Francesco De Cobelli, Gabriele Piffaretti, Matteo Tozzi, Giulio Carcano and Federico Fontana

J. Clin. Med. 2021, 10(11), 2520; https://doi.org/10.3390/jcm10112520 - 7 Jun 2021

Cited by 25 | Viewed by 7261

Abstract

Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive [...] Read more.

Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator’s experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

21 pages, 2637 KiB

Open AccessReview

Safety, Efficacy, and Outcomes of N-Butyl Cyanoacrylate Glue Injection through the Endoscopic or Radiologic Route for Variceal Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

by Olivier Chevallier, Kévin Guillen, Pierre-Olivier Comby, Thomas Mouillot, Nicolas Falvo, Marc Bardou, Marco Midulla, Ludwig-Serge Aho-Glélé and Romaric Loffroy

J. Clin. Med. 2021, 10(11), 2298; https://doi.org/10.3390/jcm10112298 - 25 May 2021

Cited by 12 | Viewed by 4645

Abstract

We performed a systematic review and meta-analysis of published studies to assess the efficacy, safety, and outcomes of N-butyl cyanoacrylate (NBCA) injection for the treatment of variceal gastrointestinal bleeding (GIB). The MEDLINE/PubMed, EMBASE, and SCOPUS databases were searched for English-language studies published from [...] Read more.

We performed a systematic review and meta-analysis of published studies to assess the efficacy, safety, and outcomes of N-butyl cyanoacrylate (NBCA) injection for the treatment of variceal gastrointestinal bleeding (GIB). The MEDLINE/PubMed, EMBASE, and SCOPUS databases were searched for English-language studies published from January 1980 to December 2019 and including patients who had injection of NBCA for variceal GIB. Two independent reviewers extracted and evaluated the data from eligible studies. Exclusion criteria were sample size < 5, article reporting the use of NBCA with other embolic agents, no extractable data, and duplicate reports. NBCA was injected during endoscopy in 42 studies and through a direct percutaneous approach for stomal varices in 1 study. The study’s endpoints were: Technical success, 30-day rebleeding, and 30-day overall and major complications. The estimated overall rates were computed with 95% confidence intervals, based on each study rate, weighted by the number of patients involved in each study. In total, 43 studies with 3484 patients were included. The technical success rate was 94.1% (95% CI: 91.6–96.1%), the 30-day rebleeding rate was 24.2% (18.9–29.9%), and 30-day overall and major complications occurred in 15.9% (11.2–21.3%) and 5.3% (3.3–7.8%) of patients, respectively. For treating variceal GIB, NBCA injection is a safe and effective method that demonstrates high technical success rate and very low major complication rate. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

► Show Figures

Figure 1

Other

Jump to: Editorial, Research, Review

16 pages, 313 KiB

Open AccessSystematic Review

Microballoon Interventions for Liver Tumors: Review of Literature and Future Perspectives

by Pierleone Lucatelli, Bianca Rocco, Simone Ciaglia, Elio Damato, Cristina Mosconi, Renato Argirò and Carlo Catalano

J. Clin. Med. 2022, 11(18), 5334; https://doi.org/10.3390/jcm11185334 - 11 Sep 2022

Cited by 4 | Viewed by 1735

Abstract

Background: Microballoon interventions (MBIs) have been proposed as useful tools to improve the efficacy of locoregional liver treatments. The aim of this systematic review was to summarize the existing evidence on procedural characteristics, safety, and efficacy of MBIs. Methods: PubMed and Cochrane Central [...] Read more.

Background: Microballoon interventions (MBIs) have been proposed as useful tools to improve the efficacy of locoregional liver treatments. The aim of this systematic review was to summarize the existing evidence on procedural characteristics, safety, and efficacy of MBIs. Methods: PubMed and Cochrane Central Register of Controlled Trials were queried for original research articles evaluating MBIs in patients with liver malignancies from 2012 to August 2022. Search terms employed were liver malignancies, hepatocellular carcinoma, cholangiocarcinoma, liver metastases, microballoon transarterial chemoembolization, balloon-occluded trans-arterial chemoembolization, balloon-occluded selective internal radiation therapies, balloon-occluded TACE and ablation, and safety or oncological results or efficacy. Merely technical studies and animal studies were excluded. Results: Thirty-four original research studies and one abstract involving 744 patients treated with MBIs were included; 76% of the studies were retrospective, with low risk of bias and moderate-to-poor levels of evidence. Heterogeneity precluded meta-analysis. All studies proved MBI safety, which was not inferior to non-occlusive procedures. Balloon employment ameliorates oncological results, improving time to recurrence, objective response rate, and lowers need for retreatment. Conclusions: MBIs appear to be potential game changers in the treatment of liver malignancies. Multicentric, prospective and randomized studies are necessary to confirm these findings. Full article

(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)

Journal Menu

Journal Browser

Embolization Techniques: State of the Art and Future Perspectives

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (25 papers)

Editorial

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI