Andre Uflacker

Meta-Analysis of Prostatic Artery Embolization for Benign Prostatic Hyperplasia

PURPOSE To perform meta-analysis of available data on prostatic artery embolization (PAE). MATERIALS AND METHODS Meta-analysis was conducted on articles published between November 2009 and December 2015. Peer-reviewed studies with > 5 patients and standard deviations and/or individual-level data on one or more of the following outcomes were included: prostate volume (PV), peak flow rate (Qmax), postvoid residual (PVR), International Prostate Symptom Score (IPSS), quality of life (QOL) score, International Index of Erectile Function (IIEF) score, and prostate-specific antigen (PSA) level. A random-effects meta-analysis was performed on the outcomes at 1, 3, 6, and 12 months after PAE compared with baseline values, with a P < .05 decision rule as the null hypothesis rejection criterion. RESULTS Nineteen of 268 studies were included in data collection, with 6 included in the meta-analysis. At 12 months, PV decreased by 31.31 cm3 (P < .001), PSA remained unchanged (P = .248), PVR decreased by 85.54 mL (P < .001), Qmax increased by 5.39 mL/s (P < .001), IPSS improved by 20.39 points (P < .001), QOL score improved by -2.49 points (P < .001), and IIEF was unchanged (P = 1.0). There were a total of 218 adverse events (AEs) among 662 patients (32.93%), with 216 being Society of Interventional Radiology class A/B (99%). The most common complications were rectalgia/dysuria (n = 60; 9.0%) and acute urinary retention (n = 52; 7.8%). No class D/E complications were reported. CONCLUSIONS PAE provided improvement in Qmax, PVR, IPSS, and QOL endpoints at 12 months, with a low incidence of serious AEs (0.3%), although minor AEs were common (32.93%). There was no adverse effect on erectile function.

Decreased Portal Vein Velocity is Predictive of the Development of Portal Vein Thrombosis: a Matched Case-Control Study

Portal vein thrombosis (PVT) in cirrhosis may lead to hepatic decompensation and increased mortality. We aimed to investigate if decreased portal vein (PV) velocity is associated with future PVT.

Transcaval Aortic Access for Percutaneous Thoracic Aortic Aneurysm Repair: Initial Human Experience

Transcaval aortic access has been used for deployment of transcatheter aortic valves in patients in whom conventional arterial approaches are not feasible. The present report describes its use for thoracic endovascular aortic repair (TEVAR) in a 61-year-old man with a descending thoracic aneurysm. Transcaval access was performed in lieu of a surgical iliac conduit in view of small atherosclerotic pelvic arteries. TEVAR was successfully performed, followed by intervascular tract occlusion with the use of a ventricular septal occluder. Computed tomography 2 d later demonstrated no extravasation. At 1 mo, the aneurysm was free of endoleaks, the aortocaval tract had healed, and the patient had returned to baseline functional status.

Vascular Access Salvage Using a Balloon- Assisted Puncture Technique

The cases presented here demonstrate that singlesession PMT can be used safely and effectively to treat extensive, acute iliofemoral DVT in pregnant patients. With proper technique, single-session PMT limits the exposure of both the mother and the fetus to thrombolytic agents and immediately restores venous flow, theoretically decreasing the risk of maternal postthrombotic syndrome. A recent study by Herrera et al (2) reports good outcomes after endovascular and surgical thrombus removal in pregnant patients with DVT; however, 10 of 11 pregnant patients treated with CDT or PMT in this study required prolonged, overnight rt-PA infusion. With an approach more committed to

The rise and fall of arterial interventions: presentations at the Society of Interventional Radiology annual scientific meeting.

PURPOSE To address hypotheses concerning a decline in presentations pertaining to vascular interventions by interventional radiologists and the loss of ground in other areas, such as oncology, of presentations in vascular interventions at the Society of Interventional Radiology (SIR) Annual Scientific Meeting. MATERIALS AND METHODS All abstracts for scientific presentations and scientific exhibits from the program book of the SIR annual meeting were reviewed from the period 1996-2006. The abstracts were grouped in different classes, such as (a) type of methodology, (b) reports on arterial interventions, (c) reports on oncologic interventions, and (d) geographic origin. RESULTS Scientific abstracts presented at the SIR annual meeting totaled 3,162. Presentations ranged from 177-407 (1996-2003) plus 250 in 2006 with a mean of 288 presentations per year. The overall number of abstracts reporting arterial interventions had a peak of 89 presentations in 2000 and declined to 34 presentations in 2006. Reports of arterial interventions from the United States had a peak of 48 presentations in 2003 and declined to 12 in 2006. Reports of arterial interventions from Europe had a peak of 37 presentations in 2000 and declined to 11 in 2006. Reports of arterial interventions from Asia had a peak of 10 presentations in 1999 and declined to 6 in 2006. The trends are similar for the three components of arterial interventions when analyzed individually. In 1997, 26.6% of all the presentations were arterial interventions; in 2000, 25.1%; and in 2006, only 13.6%. There was a trend in the increase of oncology presentations starting in 2004. In 2003, it was 10%, and it was 22.4% in 2006. CONCLUSIONS There has been a decline in the overall number of abstracts presented at the SIR annual meeting after a peak in 2003. There has been a decline in the number of arterial intervention reports. The decline in presentations of arterial interventions that originated in the United States was also observed in presentations that originated from Europe and Asia. There has been an increasing trend in interventional oncology reports starting in 2004.

Venous Compression Syndromes: a Review

Opinion statementVenous compression syndromes present a diagnostic and therapeutic challenge as the clinical presentation can be vague, diagnostic criteria are often not present, and high quality standardization of when and how to treat is not available in part due to the limited number of cases reported and also due to the limited literature available. Significant venous compression should be considered when clinical symptoms correlate to location of compression and there is evidence of hemodynamic changes including venous hypertension, collateral/variceal formation, and/or thrombus formation. In general, treatment of venous compression should address the etiology of the compression as opposed to just treating symptoms associated with it such as significant varices or anticoagulation for thrombus to avoid recurrence of symptoms.

Expulsion of prostatic tissue fragments after prostatic artery embolization

A 62-year-old man with severe LUTS/BPH presented for PAE after inadequate response to medical therapy. He underwent embolization after written informed consent using 250 μm Embozene microspheres (Boston Scientific, Natick, Massachusetts, USA) as part of an institutional review board-approved, prospective trial (NCT02592473, IDE#G150021). Baseline International Prostate Symptom Score (IPSS) was 29; Quality of Life (QoL) score of 4; postvoid residual (PVR) of 66 cc, and a Qmax of 7.9 cc/s; International Index of Erectile Function (IIEF) and UCLA Prostate Cancer Index Short-Form (UCLA-PCI-SF) were 16 and 83, respectively; prostate-specific antigen (PSA) was 3.63 ng/ml. Computed-tomography angiography revealed an 89 cm3 prostate and large median lobe (22 cm3; Figure 1). After discharge on post-procedure day 1, the patient reported bladder spasms on day 2, which improved after resuming tamsulosin 0.4 mg. He returned to clinic fourweeks post-procedure, complaining of weak stream, dysuria, and frequency. Urinalysis revealed no bacteria. During uroflowmetry, he was unable to void until he passed fragments through the urethra with scant hematuria. The specimen consisted of two irregularly shaped soft-tissue pieces measuring 1.7×1.1×0.2 cm3 and 3.1×1.0×0.5 cm3 (Figure 2). Microscopy (Figure 3) demonstrated necrotic prostate with variably-sized, irregular hyperplastic nodules surrounded by abundant stroma with corpora amylacea, and granular material (microspheres) that stained poorly with hematoxylin and eosin (H&E), but enhanced under polarized light. The 250 μm microspheres penetrated variably Expulsion of prostatic tissue fragments after prostatic artery embolization

Inferior Epigastric Uterine Artery

A 29-year-old woman, gravida 3, para 2, at 26 weeks’ gestation underwent cesarean delivery complicated by cord avulsion, placenta accreta, 3,500-mL blood loss, hemodynamic instability, and uterine atony. Left internal iliac arteriography showed 2 small left uterine arteries (Fig 1, arrows) and no obturator artery. After anterior division Gelfoam (Pfizer Inc, New York, New York) embolization, contrast reflux into the external iliac artery (Fig 2, black arrows) revealed uterine supply (Fig 2, thick white arrows) from the left inferior epigastric artery (IEA) (Fig 2, thin white arrows). An aberrant