Anobel Tamrazi

Advanced-stage hepatocellular carcinoma with portal vein thrombosis: conventional versus drug-eluting beads transcatheter arterial chemoembolization

AbstractObjectivesOur study sought to compare the overall survival in patients with hepatocellular carcinoma (HCC) and portal venous thrombosis (PVT), treated with either conventional trans-arterial chemoembolization (cTACE) or drug-eluting beads (DEB) TACE.MethodsThis retrospective analysis included a total of 133 patients, treated without cross-over and compared head-to-head by means or propensity score weighting. Mortality was compared using survival analysis upon propensity score weighting. Adverse events and liver toxicity grade ≥3 were recorded and reported for each TACE. In order to compare with historical sorafenib studies, a sub-group analysis was performed and included patients who fulfilled the SHARP inclusion criteria.ResultsThe median overall survival (MOS) of the entire cohort was 4.53xa0months (95xa0% CI, 3.63–6.03). MOS was similar across treatment arms, no significant difference between cTACE (Nu2009=u200995) and DEB-TACE (Nu2009=u200938) was observed (MOS of 5.0 vs. 3.33xa0months, respectively; pu2009=u20090.157). The most common adverse events after cTACE and DEB- TACE, respectively, were as follows: post-embolization syndrome [Nu2009=u200957 (30.0xa0%) and Nu2009=u200938 (61.3xa0%)], diarrhea [Nu2009=u20093 (1.6xa0%) and Nu2009=u20093 (4.8xa0%)], and encephalopathy [Nu2009=u200911 (5.8xa0%) and Nu2009=u20092 (3.2xa0%)].ConclusionOur retrospective study could not reveal a difference in toxicity and efficiency between cTACE and DEB-TACE for treatment of advanced stage HCC with PVT.Key Points• Conventional TACE (cTACE) and drug-eluting-beads TACE (DEB-TACE) demonstrated equal safety profiles.n • Survival rates after TACE are similar to patients treated with sorafenib.n • Child-Pugh class and tumor burden are reliable predictors of survival.

Image-guided biopsy in the era of personalized cancer care: Proceedings from the society of interventional radiology research consensus panel

Alda L. Tam, M.D., Howard J. Lim, M.D., Ignacio I. Wistuba, M.D., Anobel Tamrazi, M.D., Ph.D., Michael D. Kuo, M.D., Etay Ziv, M.D., Ph.D., Stephen Wong, Ph.D., Albert J. Shih, Ph.D., Robert J. Webster III, Ph.D., Gregory S. Fischer, Ph.D., Sunitha Nagrath, Ph.D., Suzanne E. Davis, M.M.S., M.B.A., Sarah B. White, M.D., and Kamran Ahrar, M.D. Departments of Interventional Radiology (A.L.T., K.A.) and Translational Molecular Pathology (I.I.W.); and the Division of Cancer Medicine, Research Planning and Development (S.E.D.); The University of Texas M.D. Anderson Cancer Center, Houston, TX; the Division of Medical Oncology (H.J.L.), University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; the Division of Vascular and Interventional Radiology (A.T.), Johns Hopkins University School of Medicine, Baltimore, MD; the Department of Radiological Sciences (M.D.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; the Departments of Interventional Radiology and Computational Biology (E.Z.), Memorial Sloan Kettering Cancer Center, NY, NY; the Houston Methodist Research Institute, Houston, TX and Weill Cornell Medical College of Cornell University, NY, NY (S.W.); the Departments of Mechanical and Biomechanical Engineering (A.J.S.) and the Departments of Chemical and Biomedical Engineering (S.N.), University of Michigan, Ann Arbor, MI; the Department of Mechanical Engineering (R.J.W. 3rd), Vanderbilt University, Nashville, TN; the Automation and Interventional Medicine (AIM) Robotics Lab (G.S.F.) in the Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA; and, the Division of Vascular and Interventional Radiology (S.B.W.), Medical College of Wisconsin, Milwaukee, WI

Management of High Hepatopulmonary Shunting in Patients Undergoing Hepatic Radioembolization

PURPOSEnTo review the safety of hepatic radioembolization (RE) in patients with high (≥ 10%) hepatopulmonary shunt fraction (HPSF) using various prophylactic techniques.nnnMATERIALS AND METHODSnA review was conducted of 409 patients who underwent technetium 99m-labeled macroaggregated albumin scintigraphy before planned RE. Estimated pulmonary absorbed radiation doses based on scintigraphy and hepatic administered activity were calculated. Outcomes from dose reductions and adjunctive catheter-based prophylactic techniques used to reduce lung exposure were assessed.nnnRESULTSnThere were 80 patients with HPSF ≥ 10% who received RE treatment (41 resin microspheres for metastases, 39 glass microspheres for hepatocellular carcinoma). Resin microspheres were used in 17 patients according to consensus guideline-recommended dose reduction; 38 patients received no dose reduction because the expected lung dose was < 30 Gy. Prophylactic techniques were used in 25 patients (with expected lung dose ≤ 74 Gy), including hepatic vein balloon occlusion, variceal embolization, or bland arterial embolization before, during, or after RE delivery. Repeated scintigraphy after prophylactic techniques to reduce HPSF in seven patients demonstrated a median change of -40% (range, +32 to -69%). Delayed pneumonitis developed in two patients, possibly related to radiation recall after chemoembolization. Response was lower in patients treated with resin spheres with dose reduction, with an objective response rate of 13% and disease control rate of 47% compared with 56% and 94%, respectively, without dose reduction (P = .023, P = .006).nnnCONCLUSIONSnDose reduction recommendations for HPSF may compromise efficacy. Excessive shunting can be reduced by prophylactic catheter-based techniques, which may improve the safety of performing RE in patients with high HPSF.

Decreasing Utilization of Inferior Vena Cava Filters in Post-FDA Warning Era: Insights From 2005 to 2014 Nationwide Inpatient Sample

BACKGROUNDnTo determine the impact, if any, of the 2010 FDA safety communication on the rate of inferior vena cava filter (IVCF) placement over time.nnnMETHODSnThe Nationwide Inpatient Sample was interrogated for the most recent years preceding and after the FDA safety communication-from 2005 to 2014. IVCF placements and associated diagnoses were identified using corresponding International Classification of Diseases, version nine codes. Trends in number of IVCF placement were evaluated in aggregate and by associated diagnoses, both of which were further stratified by hospital geographic cluster, hospital teaching status, and patient demographics. Generalized linear regression models were used to determine statistical significance of trends over time.nnnRESULTSnIVCF placements steadily increased between 2005 and 2010 (100,434 in 2005 versus 129,614 in 2010, growth rate 5.81%). Aggregate IVCF placements subsequently declined between 2010 and 2014 (96,005 in 2014, decline ratexa0-6.48%). IVCF placements peaked in 2010, the year of the FDA advisory. The proportion of filter placements for therapeutic indication of venous thromboembolism increased significantly during the study period (69.8% in 2005 versus 80.4% in 2014, P < .001). Neither trend varied significantly by patient demographics or hospital characteristics.nnnCONCLUSIONSnIVCF placements have declined significantly since 2010, when the FDA advisory was released. The proportion of IVCFs placed in patients with venous thromboembolism, as opposed to prophylactic indications, is increasing.

Percutaneous Retrieval of Permanent Inferior Vena Cava Filters

PurposeTo evaluate the feasibility, risks, and techniques of percutaneous removal of permanent TrapEase and Simon Nitinol IVC filters.Materials and MethodsBetween August 2011 and August 2015, 12 patients (5 women, 7 men; age range, 26–75xa0years) underwent an attempt at percutaneous removal of permanent TrapEase (10) and Simon Nitinol (2) IVC filters due to a history of IVC filter complications or need for lifelong anticoagulation due to the filter. Medical records were reviewed for filter dwell time, presence of iliocaval deep venous thrombosis, procedural technique, and complications.ResultsFilter dwell times ranged from 7xa0days to 15xa0years (mean 5.1xa0years). Successful removal of permanent IVC filters was possible in 11 of 12 patients (91.6xa0%). In 1 patient, a chronically thrombosed IVC filter could not be removed despite laser sheath assistance, but was successfully recanalized with the PowerWire RF guidewire. In the failed retrieval attempt, a stent was placed through the chronically thrombosed IVC filter with restoration of in-line flow. One major complication of large venous groin hematoma was encountered.ConclusionsIn carefully selected patients, percutaneous removal of permanent IVC filters can be performed safely despite prolonged filter dwell times. Extraction of chronically embedded permanent IVC filters may be facilitated by jugular and femoral approaches, often with laser sheath assistance. Chronic filter thrombosis and caval scarring may increase the risk of retrieval failure.

Successful Occlusion of the Splenic Artery Using the Endoluminal Occlusion System

sequelae (1). Potential treatments include removal and application of external pressure (pull and pressure), open surgical repair, endovascular stent graft placement or balloon tamponade, and percutaneous closure using a closure device (1,2). A closure device is increasingly being recognized as an alternative to surgery or endovascular approach in this iatrogenic injury. In the literature, the use of the Angio-Seal vascular closure device (St. Jude Medical, Inc., St. Paul, Minnesota) and more recently the Perclose suture-mediated closure device (Abbott Vascular) was described (1,2). The use of the StarClose device in the setting of arterial injury during CVC insertion has been limited to the subclavian and axillary artery (3,4), and the feasibility of

Percutaneous BioOrganic Sealing of Duodenal Fistulas: Case Report and Review of Biological Sealants with Potential Use in Interventional Radiology.

Biological sealants are being increasingly used in a variety of surgical specialties for their hemostatic and sealing capabilities. However, their use in interventional radiology has not been widely reported. The authors describe a case of duodenal perforation occurring after 15xa0years of gastric bypass surgery, in whom surgical diversion was unsuccessfully attempted and the leakage was successfully controlled using percutaneous administration of a combination of biological and organic sealants.