Olivier Pellerin

Cirse Quality Assurance Document and Standards for Classification of Complications: The Cirse Classification System

Interventional radiology provides a wide variety of vascular, nonvascular, musculoskeletal, and oncologic minimally invasive techniques aimed at therapy or palliation of a broad spectrum of pathologic conditions. Outcome data for these techniques are globally evaluated by hospitals, insurance companies, and government agencies targeting in a high-quality health care policy, including reimbursement strategies. To analyze effectively the outcome of a technique, accurate reporting of complications is necessary. Throughout the literature, numerous classification systems for complications grading and classification have been reported. Until now, there has been no method for uniform reporting of complications both in terms of definition and grading. The purpose of this CIRSE guideline is to provide a classification system of complications based on combining outcome and severity of sequelae. The ultimate challenge will be the adoption of this system by practitioners in different countries and health economies within the European Union and beyond.

Chronic Mesenteric Ischemia: A Rare Cause of Chronic Abdominal Pain

BACKGROUND Chronic mesenteric ischemia is a rare disease with nonspecific clinical symptoms, such as chronic postprandial abdominal pain and weight loss. Diagnostic modalities and revascularization techniques have evolved during the past 20 years. The significance of stenosis in a single splanchnic vessel remains unclear. Our aims were to assess the outcomes of 2 revascularization techniques and report on the diagnostic modalities of splanchnic vessel stenoses. METHODS The demographic data, medical history, technical characteristics, and outcomes of the revascularization procedures were recorded for all of the patients admitted for endovascular revascularization or open surgical revascularization of the splanchnic vessels as treatment for chronic mesenteric ischemia in our tertiary referral center since 2000. RESULTS Fifty-four patients were included in this study: 43 received endovascular revascularization, and 11 had open surgical revascularization. The symptoms were abdominal pain, weight loss, and diarrhea in 98%, 53%, and 25% of the cases, respectively. Computed tomography angiography was the key diagnostic tool for 60% of the patients. A single-vessel stenosis was found in one-third of the patients. Endovascular and open revascularization had similar early and late outcomes, and no 30-day mortality was observed. However, we did observe higher morbidity in the open revascularization group (73% vs 19%, P <.03). CONCLUSIONS Chronic mesenteric ischemia may be diagnosed in the presence of a splanchnic syndrome and stenosis of a single splanchnic vessel, typically assessed using computed tomography angiography. In selected patients, endovascular revascularization had similar efficacy as, and lower complication rates than open revascularization.

Complete pathological response of unresectable liver metastases from colorectal cancer after trans-arterial chemoembolization with drug-eluting beads loaded with irinotecan (DEBIRI) and concomitant systemic FOLFOX: A case report from the FFCD 1201 trial.

INTRODUCTION Most liver metastases from colorectal cancer (CRC) are unresectable at diagnosis. Systemic chemotherapy allows secondary surgical resection in 10 to 20% of patients. Hepatic intra-arterial treatments could enhance response and resection rate. We therefore designed a prospective phase II trial testing the transarterial chemoembolization (TACE) using drug-eluting beads loaded with irinotecan (DEBIRI) with concomitant systemic FOLFOX regimen, the FFCD 1201 trial, in patients with liver limited metastatic CRC. CASE REPORT A 48-year old patient was operated from an occlusive sigmoid adenocarcinoma. Magnetic resonance imaging showed 6 bilobar liver metastasis. The patient was considered as non-eligible for surgery initially. Patient was included in the FFCD 1201 trial and received 5 cycles of FOLFOX and 2 sessions of DEBIRI, with a quite good tolerability. Post-treatment evaluation showed a partial response and sufficient tumor shrinkage to make liver metastasis resectable. Right hepatectomy associated with wedge resection in the left liver was performed and pathological findings showed a complete pathological response (CPR). CONCLUSION Combination of DEBIRI with FOLFOX could increase tumor shrinkage leading to secondary resection of liver metastases from CRC. This combination may also, as shown here for the first time in a patient with unresectable LM, induce CPR of all LM, known to be associated with better outcome. Our case also emphasizes the difficulty to morphologically assess pathological response and the need for new tool to better select patients who should be resected. Further results of the FFCD 1201 trial will bring more information on this new combination therapy.

Percutaneous Manual Aspiration Embolectomy of Renal Vein Thrombosis Due to Acute Pyelonephritis

We report the case of a 50-year-old man who presented to our institution with septic thrombosis of the renal vein which had not resolved despite several days of antibiotic therapy. Optimal restoration of renal vein flow was obtained by percutaneous manual aspiration embolectomy (PMAE) in this patient with contraindication to fibrinolytic therapy and surgery.

Variants of Patterns of Intra- and Extra-prostatic Arterial Distribution of the Prostatic Artery Applied to Prostatic Artery Embolization: Proposal of a Classification

The development of prostatic artery embolization has led to better understand the complex male pelvic arterial anatomy. To the best of our knowledge, there is still no precise description of the distribution of the branches of the prostatic artery (PA) after its origin. In this study, the patterns of prostatic feeders near to and into the prostate were analyzed, and a classification was proposed.Materials and MethodsThis study is based on angiograms of 101 consecutive male patients, mean age 70, who underwent PAE between December 2013 and June 2016, to treat symptomatic benign prostatic hyperplasia.ResultsThe proposed classification is derived from the analysis of 143 solitary PAs from 199 hemipelves (72%). Pattern A was defined as an artery feeding only the prostate, patterns B and C as a PA with a concomitant large supply to the penis (pattern B) or to the rectum (pattern C). A pattern A was found in 89/143 (62%), a pattern B in 16/143 (12%) and pattern C in 38/143 (26%). Protection of a penile/rectal supply was never required in pattern A, while it was performed in 14/16 (87%) of pattern B, and in 7/38 (18%) of pattern C PAs. The PErFecTED technique could be performed in 51%, 50 and 55% of cases in pattern A to C.ConclusionThis study proposes a new classification of intra-/extra-prostatic arterial distribution of the PA that could be helpful to prevent complications of PAE. Further prospective angiographic investigations are necessary to confirm its clinical value.