Sriharsha Athreya

Meta-analysis of cryoablation versus microwave ablation for small renal masses: is there a difference in outcome?

PURPOSE We aimed to compare local and metastatic recurrence of small renal masses primarily treated by cryoablation or microwave ablation. MATERIALS AND METHODS The MEDLINE, CINAHL, and PUBMED databases were searched to review the treatment of small renal masses with cryoablation or microwave ablation. Fifty-one studies met the inclusion criteria. RESULTS Fifty-one studies representing 3950 kidney lesions were analyzed. No differences were detected in the mean patient age (P = 0.150) or duration of follow-up (P = 0.070). The mean tumor size was significantly larger in the microwave ablation group compared with the cryoablation group (P = 0.030). There was no difference between microwave ablation and cryoablation groups in terms of primary effectiveness (93.75% vs. 91.27%, respectively; P = 0.400), cancer-specific survival (98.27% vs. 96.8%, respectively; P = 0.470), local tumor progression (4.07% vs. 2.53%, respectively; P = 0.460), or progression to metastatic disease (0.8% vs. 0%, respectively; P = 0.120). Patient age was predictive of overall complications in the multivariate analysis (P = 0.020). Local tumor progression with cryoablation was predicted by the mean follow-up duration using univariate (P = 0.009) and multivariate regression (P = 0.003). Clear cell and angiomyolipoma were more frequent in the microwave ablation group (P < 0.0001 and P = 0.03328, respectively), and papillary, chromophobe, and oncocytoma were more frequent in the cryoablation group (P < 0.0001, P < 0.0001, and P = 0.0004, respectively). Open access was used more often in the microwave ablation group than in the cryoablation group (12.20% vs. 1.04%, respectively; P < 0.0001), and percutaneous access was used more frequently in the cryoablation group than in the microwave ablation group (88.64% vs. 37.20%, respectively; P = 0.0021). CONCLUSION There is no difference in local or metastatic recurrence between cryoablation- and microwave ablation-treated small renal masses.

Imagine IR symposium: an approach to increasing IR awareness and understanding among medical students.

treatment methods are determined on a case-by-case basis. A 2013 literature review by Saeki et al (1) identified 13 cases, from 11 reports, of bleeding ectopic varices at the sites of previous choledochojejunostomies. In that series, interventional radiologic techniques were employed in eight patients, including dilation and stent implantation of the portal vein (n 1⁄4 5) and embolization of varices (n 1⁄4 3). None of these cases involved percutaneous creation of an extraanatomic shunt as performed in the present case. Decompression of splenic outflow with an extraanatomic shunt was effectively established in the patient described

A meta-analysis of prostatic artery embolization in the treatment of symptomatic benign prostatic hyperplasia

Purpose: To determine if lower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH) can be effectively and safely treated by prostatic artery embolization (PAE) in men with glands 80-150 cm. Materials: Inclusion criteria for enrollment included prostate volume 80-150 cm, severe LUTS secondary to BPH and a low suspicion for prostate cancer. Baseline data included International Prostate Symptom Scoring (IPSS), Quality of Life score (QoL), International Index of Erectile Function (IIEF), maximum urine flow rate (Qmax), post-void residual volume (PVR), serum prostate specific antigen level (PSA) and prostate volume (PV). PAE was performed with 300-500 micron gelatin spheres. 1 and 3 mo follow-up data included IPSS, QoL, IIEF, PVR and Qmax. Cystoscopy and anoscopy were performed at 1 mo follow-up. Technical success was defined as bilateral embolization and clinical success was defined as 25% reduction of IPSS or 1 pt decrease in QoL. Results: Technical success was achieved in 100% (11/11) patients. Clinical success was 82% (9/11) at 1 mo and 88% (7/8) at 3 mo. See accompanying table for longitudinal data. There were only self-limiting minor complications including small access site hematoma (1/11), hematospermia (1/11), urinary retention (1/11) and urinary incontinence (2/11). Conclusions: PAE was safe and effective in this small cohort of men with prostate volume of 80-150 cm3.

Reducing Blood-borne Exposure in Interventional Radiology: What the IR Should Know

Interventional radiologists are at risk of exposure to blood-borne pathogens in their day-to-day practice. Percutaneous exposure from unsafe sharps handling, mucocutaneous exposure from body fluid splashes, and glove perforation from excessive wear can expose the radiologist to potentially infectious material. The increasing prevalence of blood-borne pathogens, including hepatitis B and C, and human immunodeficiency virus, puts nurses, residents, fellows, and interventional radiologists at risk for occupational exposure. This review outlines suggestions to establish a culture of safety in the interventional suite.