G. Frey

Single-institution experience of radioembolization with yttrium-90 microspheres for unresectable metastatic neuroendocrine liver tumors: Y-90 treat liver neuroendocrine tumor

The aim of this study was to assess the effectiveness of yttrium‐90 (90Y) microspheres for the treatment of unresectable metastatic liver neuroendocrine tumors (NET).

Segmental Arterial Mediolysis: A Case of Mistaken Hemorrhagic Pancreatitis and Review of the Literature

CONTEXT Segmental arterial mediolysis is an uncommon, non-atherosclerotic, non-inflammatory arteriopathy that involves areas of dissecting aneurysms and strictures that are caused by outer media lysis of the arterial wall from areas of medial necrosis of uncertain pathogenesis. It has a predilection for splanchnic arteries and often presents as abdominal pain or hemorrhage in late middle-aged and elderly patients. Diagnosis can be established by computed tomography angiography, magnetic resonance angiography, or angiogram by visualizing typical abnormalities, in addition to excluding other vasculitides. Histological confirmation is the gold standard but is not easily accessible and, as such, is not frequently performed. CASE REPORT Here we present an updated review of the literature and a case of segmental arterial mediolysis that presented with spontaneous intra-abdominal bleeding near the pancreas that was originally misdiagnosed as hemorrhagic pancreatitis. CONCLUSION Diagnosis is important because immunosuppressants for vasculitis can worsen the arteriopathy. Segmental arterial mediolysis can be self-limiting without treatment or may require urgent surgical or endovascular therapy for bleeding and carries a 50% mortality rate. Therefore, it should be included in the differential of causes of abdominal pain as well as in cases of unexplained abdominal hemorrhage.

Image-Guided Renal Intervention

The role of interventional radiology in the management of renal malignancy has expanded in the past 2 decades, largely because of the efficacy of image-guided ablation in treating renal cell carcinoma (RCC). Clinical guidelines now incorporate ablation into standardized RCC management algorithms. Importantly, both radiofrequency ablation and cryoablation have shown long-term durability in the definitive treatment of RCC, and early outcomes following microwave ablation are equally promising. While selective renal artery embolization has a role in the palliation of select patients with RCC, it can also be used to minimize complications in the ablation of larger renal masses.

Percutaneous Retrograde Transhepatic Arterial Puncture to Regain Access in the True Lumen of the Dissected and Acutely Occluded Transplant Hepatic Artery.

Iatrogenic hepatic artery dissection is a serious complication that can progress to complete hepatic artery occlusion and graft loss. Restoration of arterial flow to the graft is urgent, but the severity and extent of the dissection may interfere with endovascular techniques. The authors describe a technique of percutaneous retrograde transhepatic arterial puncture to regain access into the true lumen of the dissected hepatic artery to restore in‐line flow to the liver graft.

Percutaneous Computed Tomography-Guided Radiotracer-Assisted Localization of Difficult Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery

OBJECTIVE To report our institutional experience with radiotracer-assisted localization of lung nodules (RALN) in combination with uniportal video-assisted thoracoscopic surgery (UVATS). METHODS We retrospectively reviewed electronic medical records and radiology images of 27 consecutive adult patients who underwent planned UVATS lung resections combined with RALN from January 2014 to May 2017. Based on preoperative imaging, 29 nondescript nodules were marked with technetium 99 m macroaggregated albumin under computed tomography guidance before resection. Perioperative outcomes were analyzed. RESULTS All 29 nodules were successfully marked and resected with negative margins by UVATS; 12 (41.5%) were pure ground-glass opacities. Three patients had prior ipsilateral lung resections. There were no conversions to multiport VATS or thoracotomy. The majority (86.5%) of the nodules were malignant. The median nodule size was 8 mm (range: 3-20 mm) and depth, 56 mm (range: 22-150 mm). The majority (21/27; 77.8%) of patients underwent wedge resections alone, while 6 patients had anatomical resections. Median times were as follows: radiotracer injection to surgery, 219 minutes (range: 139-487 minutes); operative time, 85.5 minutes (32-236 minutes); chest tube removal, 1 day (range: 1-2 days); and length of stay, 2 days (range: 1-4 days). Four patients (14.8%) had a pigtail catheter placed for pneumothorax after radiotracer injection. One patient was readmitted 1 week after discharge for a spontaneous pneumothorax. There were no other morbidities or any 90-day mortality. CONCLUSION RALN can be combined with UVATS to effectively resect small, deep, or low-density lung lesions that are difficult to visualize or palpate by thoracoscopy.

Feraheme-Enhanced Magnetic Resonance Angiography (FEMRA) vs. Digital Subtraction Angiography in the Diagnosis and Treatment of Peripheral Vascular Disease in Patientswith Renal Insufficiency

Background: Ferumoxytol is an Ultrasmall Superparamagnetic Iron Oxide (USPIO) which has demonstrated promise as a novel contrast agent with an excellent safety profile in patients with CKD. Our aim was to evaluate the safety and utility of this agent for diagnosis and operative planning in the setting of PAD and CKD. A comparison with digital subtraction angiography is also provided. Methods: Between April, 2013 and September, 2014 seven patients with renal insufficiency (CKD ≥ Stage 3) and symptomatic PAD underwent Fe-MRA. This was followed by DSA limited to the vascular bed with significant stenosis as detected by Fe-MRA. Renal function was assessed before and after each procedure. Images were qualitatively scored at the iliac, femoral, popliteal and tibial levels by two interventional radiologists. Degree of stenosis was also scored for comparison. Results: Seven male patients were studied with a mean age of 75 years (64-92). 5 therapeutic procedures (4 endovascular and 1 open) were performed. There were no statistically significant differences in creatinine or GFR after Fe-MRA or DSA. Iodinated contrast load (mg I) for DSA was reduced in comparison with age and disease matched controls (8240 ± 5206 vs. 29320 ± 15605, p=0.001). No statistically significant differences were found for degree of stenosis or mean image quality score below the iliac level. There were no adverse events in response to Ferumoxytol administration. Conclusion: Fe-MRA provides image quality and estimation of degree of stenosis comparable to DSA. Fe-MRA may serve as an alternative to CTA or gadoliniumbased MRA for patients with end-stage renal disease.