Ari J. Isaacson

Technical Feasibility of Prostatic Artery Embolization From a Transradial Approach

OBJECTIVE The objective of this study was to evaluate the technical feasibility of performing prostatic artery embolization (PAE) with a transradial approach (TRA). Nineteen consecutive PAEs performed using a TRA were reviewed to determine the technical success of the procedure, which was defined as bilateral embolization. Procedural details, complications, and limitations were recorded. CONCLUSION Technical success was achieved in all 19 procedures. The associated complications were minor and included two small (< 5 cm) hematomas and one potential case of delayed radial arteritis. PAE performed with a TRA is technically feasible.

The Role of PET Imaging Before, During, and After Percutaneous Hepatic and Pulmonary Tumor Ablation.

The combination of anatomic and metabolic information provided by positron emission tomography (PET)/computed tomography makes it an important imaging modality to be obtained in conjunction with percutaneous ablation of primary and secondary malignancies of the lungs and liver. Advantages include more accurate preprocedural staging to determine appropriate treatment options, intraprocedural guidance to target difficult-to-see lesions, and postprocedural detection of residual or recurrent disease. Future applications of PET include strategies for intraprocedural guidance with real-time determination of incompletely ablated tumor, and combined PET/magnetic resonance imaging before, during, and after ablation for greater sensitivity to detect disease.

Prostatic Artery Embolization Using Embosphere Microspheres for Prostates Measuring 80–150 cm3: Early Results from a US Trial

Between November 2014 and October 2015, 12 patients with prostates measuring 80-150 cm(3) and lower urinary tract symptoms (LUTSs) were enrolled in a prospective single-center US trial to evaluate Embosphere Microspheres for use in prostatic artery embolization (PAE). At 3 months, mean improvements in International Prostate Symptom Score and quality of life score were 18.3 points (range, 5-27) and 3.6 points (range, 1-6), respectively. One-month cystoscopies and anoscopies demonstrated no ischemic injuries. There were no major complications. In this cohort, Embosphere Microspheres, when used for PAE, were safe and effective in reducing LUTSs in the early follow-up period.

Short- to Midterm Safety and Efficacy of Prostatic Artery Embolization: A Systematic Review

PURPOSE To review the available safety and efficacy data for prostatic artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS PubMed was searched for publications that included PAE for the treatment of BPH through May 2015. Two independent reviewers determined the appropriateness for inclusion of each article and compiled data by using pooled weighted means and standard deviations. RESULTS The literature search identified 161 articles, of which 7 studies, with a total of 562 patients, met all inclusion/exclusion criteria. PAEs were performed bilaterally in 85% of patients, unilaterally in 12%, and unsuccessfully in 3%. International Prostate Symptom Score decreased from 24.51 ± 6.12 at baseline to 10.42 ± 5.39 at 6 months. Quality of life score decreased from 4.76 ± 0.98 at baseline to 2.51 ± 1.13 at 6 months. Peak urinary flow rate increased from 8.41 mL/s ± 2.63 at baseline to 15.44 mL/s ± 5.64 at 6 months. Postvoid residual measurement decreased from 105.94 mL ± 76.77 at baseline to 39.57 mL ± 15 at 6 months. Prostate-specific antigen level decreased from 4.79 ng/mL ± 5.42 at baseline to 3.16 ng/mL ± 1.5 at 6 months. None of these parameters showed clinically significant changes from 6 months to 12 months. Total prostate volume decreased from 96.56 cm3 ± 35.47 at baseline to 46.73 cm3 ± 20.51 at 12 months. There were 200 minor complications and 1 major complication. CONCLUSIONS PAE improves lower urinary tract symptoms caused by BPH, with a favorable short- to midterm safety profile.

Comparison of Type II Endoleak Embolizations: Embolization of Endoleak Nidus Only versus Embolization of Endoleak Nidus and Branch Vessels

PURPOSE To compare outcomes of type II endoleak embolization involving embolization of the endoleak nidus only vs embolization of the endoleak nidus and branch vessels in patients treated with endovascular repair of abdominal aortic aneurysms. MATERIALS AND METHODS Twenty-nine consecutive patients (mean age, 77.9 y; range, 63-88 y) with type II endoleak who underwent embolization from 2004 to 2015 were retrospectively reviewed. Patients were divided into 2 groups: embolization of endoleak nidus only (group A) and embolization of endoleak nidus and branch vessels (group B). Mean follow-up intervals were 20.5 months ± 14.7 in group A and 24.3 months ± 18.5 in group B. Outcomes were compared between groups by Mann-Whitney U and Pearson χ2 tests. RESULTS Mean interval from endovascular aneurysm repair to embolization was 47.6 months ± 42.9, and mean presentation time of endoleak before embolization was 23.1 months ± 25.8. Coils (n = 28) and liquid embolic agents (n = 23) were used for embolization. There were no significant differences in rates of residual endoleak (50% vs 53.8%; P = .96) or sac decrease/stabilization (62.5% vs 61.5%; P = .64). Procedure time and radiation exposure in group B (132.3 min ± 78.1; 232.4 Gy·cm2 ± 130.7) were greater than in group A (63.4 min ± 11.9; 61.5 Gy·cm2 ± 35.5; P < .01). There were no procedure-related complications. CONCLUSIONS Embolization of the endoleak nidus and branch vessels is not superior to embolization of only the nidus in terms of occlusion of type II endoleak and change in sac size despite requiring longer procedure times and resulting in greater patient radiation exposure.

Utility of Pelvic Computed Tomography Angiography Prior to Prostatic Artery Embolization.

Pelvic computed tomography angiography (CTA) prior to prostatic artery embolization is a beneficial tool for preprocedural planning to increase the likelihood of success during what can be a challenging procedure. Additionally, the same CTA images can be used for calculating the baseline prostate volume as well as for intraprocedural anatomic guidance, adding to the value of the scan. This article discusses the technique used for pelvic CTA and its role in preprocedural assessment of the pelvic vasculature prior to prostatic artery embolization.

Factors that predict increased catheter tip movement in left internal jugular vein implantable venous access ports upon standing

Purpose To determine the characteristics that predict catheter tip movement with positional changes in patients with left-sided, internal jugular vein (IJV) implantable venous access ports. Methods A retrospective review revealed 264 patients with left IJV ports placed at one academic institution from 2008 to 2013 with follow-up upright chest radiographs. Demographic information was recorded and anatomic measurements were made on both procedural fluoroscopic imaging and upright chest radiographs. Multivariate regression analysis was performed to determine which factors had statistically significant relationships with catheter tip movement distance. Results Mean catheter tip movement was 1.49 ± 1.97 cm. There was a statistically significant positive relationship between catheter tip movement distance and age (p = 0.03), body mass index (BMI) (p = 0.02), innominate vein angle (p<0.01) and dual- compared to single-lumen ports (p = 0.02). Port pocket location, venous access site and gender did not demonstrate statistical significance. Conclusions The factors associated with increased positional catheter tip movement for left IJV ports include patient age, BMI, innominate vein angle and dual- vs single-lumen port. This information can be useful in determining initial placement position and avoiding complications associated with catheter malposition.

Interventional Radiologic Placement of Denver Pleuroperitoneal Shunt for Refractory Chylothorax

demonstrated an effusion with large-volume chylous fluid draining from his thoracostomy tube, with daily output ranging from 0.5 to 3.5 L (Fig. 1). The chylothorax did not improve after a fat-restricted diet, total parenteral nutrition, repeat surgical thoracic duct ligation, and pleurodesis. Additional procedures, including intranodal lymphangiography with cisterna chyli embolization (postoperative days 16 and 17) and thoracic duct needle disruption with alcohol ablation (postoperative day 31), were also performed, without resolution of the effusion. Forty-nine days after the initial surgery and hospitalization, a consensus decision was made to percutaneously create a pleuroperitoneal shunt. The procedure was performed under general anesthesia in the interventional radiology suite. Preprocedural ampicillin/sulbactam (Unasyn; Pfizer, New York, New York) was administered. A 3-cm transverse incision was made over the ninth to 11th ribs in the right lateral chest

Initial Experience with Balloon-Occlusion Prostatic Artery Embolization

Twelve patients underwent balloon-occlusion prostatic artery embolization (PAE) at a single center. Bilateral prostatic artery catheterization was achieved in all patients, but unilateral embolization was performed in 1 patient as a result of the presence of a prostatic arteriovenous fistula. Mean International Prostate Symptom Score and quality-of-life score decreased by 15 ± 7 (P < .01) and 4 ± 1 (P < .01) points, respectively, over a mean follow-up period of 22 weeks ± 8. Only self-limiting minor complications were encountered. The initial experience with balloon-occlusion PAE suggests that it is technically feasible and can be performed safely.

Acalculous Cholecystitis in Burn Patients: Is There a Role for Percutaneous Cholecystostomy?

Although acute acalculous cholecystitis is uncommon in burn patients, this condition can be rapidly fatal due to delays in diagnosis and treatment and should always be considered in the differential diagnosis when burn patients become septic, develop abdominal pain, or have hemodynamic instability. This article reviews the use of percutaneous cholecystostomy in burn patients as both a diagnostic and therapeutic intervention.