Cancer-Associated Venous Thromboembolic Disease, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology.

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cancer-Associated Venous Thromboembolic Disease focus on the prevention, diagnosis, and treatment of patients with cancer who have developed or who are at risk for developing venous thromboembolism (VTE). VTE is a significant concern among cancer patients, who are at heightened risks for developing as well as dying from the disease. The management of patients with cancer with VTE often requires multidisciplinary efforts at treating institutions. The NCCN panel comprises specialists from various fields: cardiology, hematology/hematologic oncology, internal medicine, interventional radiology, medical oncology, pharmacology/pharmacy, and surgery/surgical oncology. This article focuses on VTE prophylaxis for medical and surgical oncology inpatients and outpatients, and discusses risk factors for VTE development, risk assessment tools, as well as management methods, including pharmacological and mechanical prophylactics. Contraindications to therapeutic interventions and special dosing, when required, are also discussed.

Infection Rates Following Hepatic Embolotherapy in Patients with Prior Biliary Interventions: Comparison of Single-Drug Moxifloxacin and Multidrug Antibiotic Prophylaxis.

PURPOSE: To investigate the incidence of infection in patients with prior biliary interventions undergoing hepatic embolotherapy following extended antibiotic prophylaxis using moxifloxacin monotherapy or a multidrug regimen. MATERIAL AND METHODS: Under an Institutional Review Board-approved protocol, retrospective review of a quality assurance database identified all liver-directed therapies (LDTs) at a tertiary care center between 2010 and 2019 with biliary intervention prior to LDT Records were reviewed for infectious complications within 3 months of chemo- or radioembolization. Patients were categorized based on extended antibiotic prophylaxis regimen: oral moxifloxacin monotherapy or multidrug regimen of levofloxacin and metroniodazole plus preprocedural neomycin and erythromycin. Procedures without at least 2 months of clinical follow-up, hepatic ablation, and procedures without extended antibiotic prophylaxis were excluded Regression analysis was used to analyze multivariate data to detect a difference in infection rate. RESULTS: Twenty-four chemoembolization and 58 radioembolization procedures were performed on 55 patients with prior biliary interventions. Forty-four used monotherapy and 38 used multidrug regimen. The incidence of infection was 16.7% (4/24) after chemoembolization and 13.8% (8/58) after radioembolization The incidence of infection in patients did not differ between antibiotic prophylaxis regimens (18.2% [8/44] with moxifloxacin monotherapy and 10.5% [4/38] multidrug regimen, P = .3) or between types of biliary interventions (24.1% [7/29] with bilioenteric anastomosis and 23.8% [5/21] biliary stenting, P = .3). CONCLUSIONS: The types of extended antibiotic prophylaxis (moxifloxacin monotherapy vs multitherapy), prior biliary intervention, and embolotherapy were not found to be associated with differences in the incidence of infectious complications in this population.

Endovascular Treatment of an Anatomically Complex Iliac Lesion and a Review of Variant Iliac Venous Anatomy.

The diagnosis and treatment of pelvic venous disease is complicated by a number of potential venous anatomic variants. Stent-assisted recanalization of a chronically occluded left external iliac vein draining directly into the inferior vena cava, with absence of the left common iliac vein, is described here. Variant iliac venous anatomy is reviewed in 3 categories: additional iliac vessels, absence/shortening of iliac vessels, and deviations in the drainage pattern of iliac vessels. Additionally, variations of the ascending lumbar and iliolumbar veins, the identification of which can aid in the treatment of pelvic venous disease, are described.

Chronic Hepatotoxicity in Patients with Metastatic Neuroendocrine Tumor: Transarterial Chemoembolization versus Transarterial Radioembolization.

PURPOSE: To compare the manifestations of chronic liver injury following transarterial chemoembolization with those of transarterial radioembolization (TARE) in patients with neuroendocrine tumor (NET). MATERIALS AND METHODS: This study consisted of an Institutional Review Board-approved single-institution retrospective analysis of NET patients who received transarterial chemoembolization from 2006 to 2016 and TARE from 2005 to 2014 and survived at least 1 year from the initial treatment. Patients receiving only transarterial chemoembolization (n = 63) or TARE (n = 28) were evaluated for the presence or absence of durable hepatic toxicities occurring at least 6 months after initial treatment. The definitions and grades of liver injury were adapted from Common Terminology Criteria for Adverse Events version 4.0 and were characterized by the presence of laboratory or clinical toxicities of Grade 3 or above. RESULTS: Chronic hepatic toxicity occurred in 14 of 63 transarterial chemoembolization patients (22%) with a total of 26 Grade 3-4 events, in whom elevation of bilirubin was the most common toxicity, compared to 8 of 28 TARE patients (29%) with a total of 16 Grade 3-4 and 2 Grade 5 events, in whom ascites were the most frequent toxicity. There were more laboratory toxicities in the transarterial chemoembolization group (65% vs 38%, P = .11) and fewer Grade 4-5 injuries (6% vs 27% of patients, P = .06). There was also a significantly higher number of patients who experienced intrahepatic progression of disease in the transarterial chemoembolization cohort than in the TARE patients (75% vs 43%, respectively; P = .005). CONCLUSIONS: Delayed hepatotoxicity from transarterial chemoembolization and TARE occurred in 22% and 29% of patients, respectively, from 6 months to several years following treatment. Transarterial chemoembolization-related toxicities on average were less severe and manifested primarily as laboratory derangements, compared to TARE toxicities which consisted of clinical hepatic decompensation.

Inferior Vena Cava Reconstruction in Symptomatic Patients Using Palmaz Stents: A Retrospective Single-Center Experience.

BACKGROUND: The use of stents for treating central venous occlusion is well described. Limited evidence exists related to Palmaz balloon-expandable stent use in inferior vena cava (IVC) reconstruction. We analyzed patency and complication rates after IVC reconstruction using Palmaz stents. METHODS: From 2002 to 2019, 37 patients (mean age: 51 year) underwent IVC reconstruction with 68 Palmaz stents. Indications were symptomatic chronic venous obstruction in the infrarenal (n = 25) and intrahepatic (n = 12) IVC. Demographic, operative, and imaging data were evaluated. Clinical data, abdominal CT, and/or duplex ultrasound were used to determine patency at follow-up. RESULTS: Restoration of caval patency was achieved in all patients, with complications in 2/37 (5.4%) patients (thrombus formation within the stent; stent embolization eight days after placement). Follow-up data were available for 27 patients. Primary patency was maintained through last follow-up in 19/27 (70%) patients (mean: 1.1 year), with successful stent redilation performed in 6 patients. Mean duration of primary-assisted patency (n = 5) was 1.2 year. Late lumen loss was (n = 13) was 40% during a mean time to follow-up of 2.0 years. Primary patency in patients with occlusion secondary to malignancy was 109 day (range: 1 day-1.0 year), whereas primary patency in patients with occlusion from other etiologies was 1.1 year (range: 2 day-5.9 year). The Kaplan-Meier analysis demonstrated primary and primary-assisted patency of 66% and 84%, respectively, at 24 and 48 months. CONCLUSIONS: Palmaz balloon-expandable stents for IVC reconstruction is feasible and effective for symptomatic IVC occlusion. Risk of stent migration was low.

Association of Complete Radiologic and Pathologic Response following Locoregional Therapy before Liver Transplantation with Long-Term Outcomes of Hepatocellular Carcinoma: A Retrospective Study.

PURPOSE: To evaluate long-term outcomes of patients with hepatocellular carcinoma (HCC) who show a complete response (CR) vs non-CR on pretransplantation imaging studies or pathologic evaluation of liver explants after locoregional therapy (LRT) before liver transplantation. MATERIALS AND METHODS: Patients listed for liver transplantation for HCC (March 1998 to December 2010) undergoing LRT with available multiphase MR/CT imaging before transplantation were included. Pathologic response was evaluated based on liver explant pathology. A total of 108 patients (17 women; 16%) met the inclusion criteria. RESULTS: Radiologic CR was achieved in 65 patients (60%) vs non-CR in 43 (40%), and pathologic CR was achieved in 36 patients (33%) vs non-CR in 72 (67%). Mean 5-year overall survival (OS) from the time of listing and recurrence-free survival (RFS) after liver transplantation were significantly better for patients with pathologic CR vs non-CR on explant pathology (OS, 83.3% vs 65.2% [28% difference; P = .046]; RFS, 80.6% vs 62.5% [29% difference; P = .045]). Mean 5-y OS and RFS were not significantly different between patients with radiologic CR or non-CR on pretransplantation imaging (OS, 75.4% vs 65.1% [P = .12]; RFS, 74% vs 62.8% [P = .17]). CONCLUSIONS: Achievement of a pathologic CR vs non-CR in response to LRT before liver transplantation for HCC is associated with improved OS from time of listing and improved RFS after liver transplantation. However, current imaging paradigms fall short of accurate delineation of response to LRT, resulting in poor correlation of outcomes between pathologic and radiologic CR.

A 16-F Sheath with Endobronchial Forceps Improves Reported Retrieval Success of Long-Dwelling "Closed Cell" Inferior Vena Cava Filter Designs.

PURPOSE: To report results of a 16-F sheath/endobronchial forceps combination in retrieval of "closed cell" inferior vena cava (IVC) filter designs with prolonged dwell times of ≥ 60 days. MATERIALS AND METHODS: Forceps retrieval of selected IVC filters using a 16-F 45-cm sheath was performed in 35 patients (25 women and 10 men). Patients presented with filters that were no longer needed without (n = 10) or with (n = 21) prior failed retrieval, caval thrombosis before lysis (n = 3), and back pain (n = 1). Filter designs included 19 Günther Tulip (54%), 10 Option (29%), and six OptEase (17%). Mean dwell time was 977 days. Imaging characteristics, technical success, fluoroscopy time, and complications were recorded. RESULTS: Filters included 20 tip-embedded, 6 tip-adherent, 4 fractured, and 6 containing thrombus. All were strut and wall-embedded. Initial snare failures occurred in 8 filters because of hook straightening (n = 4), adherent material (n = 2), snare breakage (n = 1), and filter tilt (n = 1). The 16-F sheath/forceps combination was 100% successful in removing filters. In 1 patient, 2 extravascular fragments could not be retrieved. Median fluoroscopy time, excluding 3 extended lysis procedures, was 8 minutes. Minor caval abnormalities, including caval spasm and caval defects, were noted in 17 patients, and filter fracture occurred in 2 patients. No major complications occurred. CONCLUSIONS: A high rate of retrieval for closed cell long-dwelling strut and wall-embedded filters may be achieved using a 16-F sheath/endobronchial forceps combination.

Role of Catheter-directed Thrombolysis in Management of Iliofemoral Deep Venous Thrombosis.

The treatment for iliofemoral deep venous thrombosis (DVT) is challenging, as the use of anticoagulation alone can be insufficient for restoring venous patency and thus lead to prolongation of acute symptoms and an increased risk of chronic complications, including venous insufficiency and postthrombotic syndrome (PTS). In these cases, earlier and more complete thrombus removal can ameliorate acute symptoms and reduce long-term sequelae. Endovascular therapies involving the use of pharmacologic, mechanical, and combined pharmacomechanical modalities have been developed to achieve these goals. The most frequently used of these techniques, catheter-directed thrombolysis (CDT), involves the infusion of a thrombolytic agent through a multiple-side-hole catheter placed within the thrombosed vein to achieve high local doses and thereby break down the clot while minimizing systemic thrombolytic agent exposure. Randomized controlled trial results have indicated decreased PTS rates and improved venous patency rates in patients treated with CDT compared with these rates in patients treated with anticoagulation. The use of newer pharmacomechanical techniques, as compared with conventional CDT, reduces procedural times and thrombolytic agent doses and is the subject of ongoing investigations. Endovascular thrombus removal techniques offer a means to improve venous valvular function and decrease the risk of debilitating long-term complications such as PTS and are a promising option for treating patients with iliofemoral DVT. (©)RSNA, 2016.

Retrieval of Tip-embedded Inferior Vena Cava Filters by Using the Endobronchial Forceps Technique: Experience at a Single Institution.

PURPOSE: To evaluate the use of endobronchial forceps to retrieve tip-embedded inferior vena cava (IVC) filters. MATERIALS AND METHODS: This institutional review board-approved, HIPAA-compliant retrospective study included 114 patients who presented with tip-embedded IVC filters for removal from January 2005 to April 2014. The included patients consisted of 77 women and 37 men with a mean age of 43 years (range, 18-79 years). Filters were identified as tip embedded by using rotational venography. Rigid bronchoscopy forceps were used to dissect the tip or hook of the filter from the wall of the IVC. The filter was then removed through the sheath by using the endobronchial forceps. Statistical analysis entailed calculating percentages, ranges, and means. RESULTS: The endobronchial forceps technique was used to successfully retrieve 109 of 114 (96%) tip-embedded IVC filters on an intention-to-treat basis. Five failures occurred in four patients in whom the technique was attempted but failed and one patient in whom retrieval was not attempted. Filters were in place for a mean of 465 days (range, 31-2976 days). The filters in this study included 10 Recovery, 33 G2, eight G2X, 11 Eclipse, one OptEase, six Option, 13 Günther Tulip, one ALN, and 31 Celect filters. Three minor complications and one major complication occurred, with no permanent sequelae. CONCLUSION: The endobronchial forceps technique can be safely used to remove tip-embedded IVC filters.

Initial Clinical Experience: Symmetric-Tip Dialysis Catheter with Helical Flow Characteristics Improves Patient Outcomes.

PURPOSE: To report preliminary clinical experience with a new symmetric-tip dialysis catheter compared with a conventional split-tip catheter. MATERIALS AND METHODS: Over a 5-month period, patients requiring a tunneled catheter for hemodialysis or undergoing exchange of a dysfunctional dialysis catheter at a tertiary academic medical center were retrospectively analyzed. Patients underwent placement of a VectorFlow or Ash Split Cath catheter at the discretion of the inserting interventional radiologist. Patient demographics, catheter patency, mean blood flow rate, and arterial and venous pressures were compared according to catheter type. Catheter failure was analyzed based on clinical and anatomic variables by using a multivariate Cox proportional-hazards model. RESULTS: A total of 33 VectorFlow and 46 Ash Split Cath catheters were placed. Patients in the VectorFlow group had significantly higher body mass index (P = .013) and Charlson Comorbidity Index (P = .049), as well as more non-internal jugular vein placements. At 120 days, 89% of VectorFlow catheters remained functional, compared with 45% of Ash Split Cath catheters (P = .046). The VectorFlow catheter was associated with 16% lower arterial pressures during dialysis (P = .009); mean blood flow rate was equivalent. On multivariate analysis, the risk of catheter failure was 13.3 times higher in the Ash Split Cath group compared with the VectorFlow group (P = .004). Left-sided catheters were also predictive of catheter failure (relative risk = 5.5; P = .02). CONCLUSIONS: The VectorFlow catheter was associated with a significant increase in intervention-free catheter patency compared with the Ash Split Cath catheter, with equivalent flow at lower arterial pressures during dialysis.

Effect of central venous angioplasty on hemodialysis access circuit flow: prospective study of 25 symptomatic patients.

PURPOSE: To quantify the effect of central venous percutaneous transluminal angioplasty (PTA) on blood flow within hemodialysis access circuits in patients with symptomatic central venous stenosis (CVS). MATERIALS AND METHODS: This prospective study enrolled 30 adults with symptoms attributable to CVS ipsilateral to their access. Five subjects were deregistered because of a lack of CVS (n = 1), untreatable lesion (n = 1), or improper flow measurement timing (n = 3); 25 completed the study (15 men and 10 women; mean age, 62 y; age range, 33-87 y). There were 7 fistulae, 15 grafts, and 3 hybrid access circuits. Mean access age was 675 days (range, 16-3,039 d). Mean CVS symptom duration was 37 days (range, 3-120 d). Peripheral stenoses, if present, were treated first. Intraaccess flow was measured immediately before and immediately after CVS treatment (PTA, stent). RESULTS: Eleven patients had only CVS, whereas 14 had at least 1 peripheral lesion in addition to CVS. All stenoses underwent PTA. Mean flow rates were 1,424 mL/min (range, 565-2,765 mL/min) before PTA and 1,535 mL/min (range, 598-2,545 mL/min) afterward, yielding a mean increase of 111 mL/min ± 456 or 15% ± 34 (range, -70% to +100%; 95% confidence interval, 1%-29%). Flow was decreased in 9 patients (36%). CVS symptoms were reduced in 24 patients (96%) and recurred in 14 (58%) within a mean of 110 days (range, 7-459 d) after initial PTA. Mean follow-up was 371 days (range, 17-592 d). CONCLUSIONS: CVS symptoms were observed to occur over a wide range of blood flow rates. On average, central venous PTA only mildly increased flow yet reduced symptoms regardless of flow change.

Outcomes of percutaneous interventions in transposed hemodialysis fistulas compared with nontransposed fistulas and grafts.

PURPOSE: To compare postpercutaneous intervention outcomes of autogenous venous-transposition arteriovenous fistulas (AVFs) versus those of autogenous nontransposed AVFs (nAVFs) and prosthetic arteriovenous grafts (AVGs). MATERIALS AND METHODS: A total of 591 hemodialysis accesses (195 transposed AVFs [tAVFs], 205 nAVFs, 191 AVGs) in 522 patients (278 male; mean age, 57 y; range, 15­91 y) underwent percutaneous transluminal angioplasty (PTA) and/or mechanical thrombectomy (ie, declotting). Access characteristics, surgical history, percutaneous interventions, postinterventional primary and secondary access patency, and follow-up data were collected. Cox proportional-hazards regression analyses, Fisher exact tests, and χ2 tests were performed. RESULTS: Mean follow-up period was 32 months. Mean access ages at initial percutaneous intervention were 260 days (tAVF), 206 days (nAVF), and 176 days (AVG; P < .01). One-year postinterventional primary patency (PIPP) rates were 25% (tAVF), 24% (nAVF), and 14% (AVG). One-year postinterventional secondary patency (PISP) rates were 77% (tAVF), 61% (nAVF), and 63% (AVG). Median PIPP durations were 138 days (tAVF), 121 days (nAVF), and 79 days (AVG; P = .0001). Median PISP durations were 1,076 days (tAVF), 783 days (nAVF), and 750 days (AVG; P = .019). Total interventions needed to maintain PISP were 2.4 (tAVF), 1.3 (nAVF), and 3.2 (AVG) per patient-year (P < .001), which included 1.9, 1.2, and 1.4 PTAs (P < .01) and 0.45, 0.15, and 1.8 declotting procedures, respectively (P < .001). CONCLUSIONS: Based on the number of percutaneous interventions needed to maintain PISP, these results confirm the current Dialysis Outcomes Quality Initiative access preference of nAVFs before tAVFs before AVGs. tAVFs offered superior postinterventional outcomes than AVGs. With additional interventions, tAVFs could even outperform nAVFs in terms of PISP.

Management of Patients when Superficial Venous Disease Arises from Pelvic Escape Points.

Chronic pelvic pain (CPP) is a common condition in women that carries with it significant morbidity. It is commonly seen in patients presenting to obstetrics and gynecology outpatient clinic visits. CPP is a presenting symptom of various pathologies including pelvic varicocele, pelvic adhesions, spastic colon syndrome, uterine fibroids, endometriosis, and psychosomatic disorders. Pelvic congestion syndrome has more recently been termed "pelvic venous insufficiency (PVI)" due to the underlying retrograde flow through incompetent ovarian and pelvic veins that are thought to cause the symptoms of CPP. Pelvic varices can commonly present alongside vulvar, perineal, and lower extremity varices. There are some predictable "escape pathways" for these varices that may present for interventional treatment. This article introduces the reader to current terminology, clinical presentation, diagnosis, and treatment of patients with pelvic varices due to PVI.

Endovascular IVC Reconstruction in an 18 Year Old Patient with Subtotal IVC Atresia.

INTRODUCTION: Inferior vena cava (IVC) atresia is an uncommon venous anomaly that is an under recognised cause of unprovoked acute deep venous thrombosis (DVT) in young adults. The purpose of this case report is to highlight endovascular IVC reconstruction as a feasible treatment option, particularly in challenging cases when other therapeutic modalities have failed. REPORT: This is the report of an 18 year old patient with near complete IVC atresia and a longstanding history of exertional nausea of unknown aetiology, who presented with extensive acute DVT. He was treated successfully by endovascular IVC reconstruction after failing initial anticoagulation and thrombolysis. Symptom resolution and venous patency were maintained at 2.5 year follow up. DISCUSSION: IVC atresia is an important aetiology to consider in a young patient presenting with unprovoked DVT. Endovascular stenting can restore venous patency and is feasible even when there is near complete IVC atresia. This case was uniquely challenging in the length of atretic IVC that was reconstructed and also highlights an atypical clinical presentation of IVC atresia.

Medical Student Education During the COVID-19 Pandemic: Initial Experiences Implementing a Virtual Interventional Radiology Elective Course.

RATIONALE AND OBJECTIVES: In response to the COVID-19 pandemic reducing medical student presence on clinical services and in classrooms, academic institutions are utilizing a virtual format to continue medical student education. We describe a successful initial experience implementing a virtual elective in interventional radiology (IR) and provide the course framework, student feedback, and potential improvements. MATERIALS AND METHODS: A 2-week virtual IR elective curriculum was created utilizing a combination of synchronous and asynchronous learning and the "flipped" classroom educational model. Students virtually participated in daily IR resident education conferences, resident-led case review sessions, and dedicated lectures. Asynchronous prelearning material consisted of text and video correlating to lecture topics. Anonymous precourse and postcourse surveys were sent to all participating students (n = 10). RESULTS: Ten students (100%) completed precourse and seven (70%) completed postcourse surveys. Enrolled students were considering residencies in surgery (50%), internal medicine (40%), interventional radiology (30%), and/or diagnostic radiology (30%). Students' understanding of what IRs do and the procedures they perform (p < 0.001), when to consult IR for assistance in patient management (p = 0.005), and the number of IR procedures students could recall (p = 0.015) improved after the course. Case-review sessions and virtual lectures ranked as having the highest education value. Students recommended additional small-group case workshops. CONCLUSION: This successful virtual IR elective provides a framework for others to continue IR medical student education during the pandemic and grow the specialty's presence within an increasingly virtual medical school curriculum. The described model may be modified to improve IR education beyond the COVID-19 era.

Variability in biopsy quality informs translational research applications in hepatocellular carcinoma.

In the era of precision medicine, biopsies are playing an increasingly central role in cancer research and treatment paradigms; however, patient outcomes and analyses of biopsy quality, as well as impact on downstream clinical and research applications, remain underreported. Herein, we report biopsy safety and quality outcomes for percutaneous core biopsies of hepatocellular carcinoma (HCC) performed as part of a prospective clinical trial. Patients with a clinical diagnosis of HCC were enrolled in a prospective cohort study for the genetic, proteomic, and metabolomic profiling of HCC at two academic medical centers from April 2016 to July 2020. Under image guidance, 18G core biopsies were obtained using coaxial technique at the time of locoregional therapy. The primary outcome was biopsy quality, defined as tumor fraction in the core biopsy. 56 HCC lesions from 50 patients underwent 60 biopsy events with a median of 8 core biopsies per procedure (interquartile range, IQR, 7-10). Malignancy was identified in 45/56 (80.4%, 4 without pathology) biopsy events, including HCC (40/56, 71.4%) and cholangiocarcinoma (CCA) or combined HCC-CCA (5/56, 8.9%). Biopsy quality was highly variable with a median of 40% tumor in each biopsy core (IQR 10-75). Only 43/56 (76.8%) and 23/56 (41.1%) samples met quality thresholds for genomic or metabolomic/proteomic profiling, respectively, requiring expansion of the clinical trial. Overall and major complication rates were 5/60 (8.3%) and 3/60 (5.0%), respectively. Despite uniform biopsy protocol, biopsy quality varied widely with up to 59% of samples to be inadequate for intended purpose. This finding has important consequences for clinical trial design and highlights the need for quality control prior to applications in which the presence of benign cell types may substantially alter findings.

Intravascular ultrasound is a key diagnostic tool in subclavian vein varicosity.

Varicose veins of the neck are far less common than lower extremity varicosities. Often, neck varicosities can be a sign of a more central venous obstruction. Here, we describe a patient with no risk factors for central venous obstruction who presented with a recurrent left subclavian vein (LSV) varicosity causing significant pain and discomfort that was recalcitrant to repeated phlebectomy. Venography revealed a dilated LSV with no significant venographic stenosis in the LSV or brachiocephalic vein. Intravascular ultrasound subsequently revealed a culprit hypertrophied valve that was successfully treated with valvuloplasty, resulting in durable resolution of the patient's symptoms, suggesting that intravascular ultrasound was essential in the diagnosis and treatment of this hypertrophied valve.

Impact of a Monthly Compliance Review on Interventional Radiology Adverse Event Reporting.

PURPOSE: Our aims were to analyze the change in interventional radiology physician major adverse event (AE) reporting after initiation of a monthly morbidity and mortality (M&M) conference compliance review and to describe the association of procedure class and potentially preventable errors with major AE occurrence. METHODS: In late 2010, to motivate timely reporting, we instituted a structured monthly M&M conference review confirming whether each complication warranted institutional AE reporting and whether timely reporting had occurred. In this study, we retrospectively analyzed the M&M conference minutes over the subsequent 5 years. Logistic regression was used to model the change of AE reporting over time as well as the association of procedure class with the risk of an AE. Each AE was classified as to whether it seemed potentially preventable. RESULTS: There were 46,660 patient encounters, 1,160 (2.5%) major and minor complications, and 462 (1.0%) reportable AEs. From 2011 to 2015, the percentage of reportable AEs reported increased from 67% to 98%. The number of months from initiation of the M&M conference review was a significant predictor of the likelihood of AE reporting (odds ratio 1.06, 95% confidence interval 1.04, 1.08, P < .0001). Procedure class was strongly associated with the risk of a reportable AE (P < .0001). At least 111 (24%) reportable AEs were potentially preventable. CONCLUSIONS: Increasing AE reporting occurred after initiation of a monthly M&M conference compliance review. The incidence of reportable AEs was strongly associated with procedure class, and a significant percentage of these events were potentially preventable.

Catheter-Directed Therapy Options for Iliofemoral Venous Thrombosis.

Proximal deep venous thrombosis (DVT) is linked to a 50% risk of pulmonary embolism and a 50% risk of postthrombotic syndrome. This article reviews catheter-directed thrombolysis options for iliofemoral DVT and discusses the risks, benefits, and techniques commonly used in performing endovascular procedures for iliofemoral DVT.

The Impact of Bridging LRT on Survival in Patients Listed for Liver Transplantation.

PURPOSE: Locoregional therapy (LRT) is recommended for certain groups of patients with hepatocellular carcinoma (HCC) listed for orthotopic liver transplantation (OLT) with expected wait times greater than 6 months. A retrospective single-center study was performed to evaluate the effect of LRT on the outcomes of patients with HCC listed for OLT. METHODS: Institutional database was reviewed to identify the patients listed for OLT with HCC (March 1998-December 2010). Patient and tumor characteristics were recorded with a follow-up period of 6.5 years from diagnosis. RESULTS: Out of 359 listed patients, 72 patients were delisted (delisted group) and 287 underwent orthotopic liver transplantation (OLT group). One hundred fifty-five and 45 patients from the OLT and delisted groups underwent locoregional therapy (LRT), respectively. Median wait time and sum of largest tumor diameter were significantly higher for patients receiving LRT. LRT was associated with significantly better survival among delisted patients at the end of follow-up (1249.6 ± 137.4 vs. 742.1 ± 155.4 days, p = 0.028). In the OLT group, survival was similar between LRT and no LRT group, but survival was significantly better in patients with largest tumor diameter ≥30 mm (1949.4 ± 95.1 vs. 1694.8 ± 135.5, p = 0.02). CONCLUSION: Patients with HCC and the largest tumor greater than 30 mm treated with LRT prior to OLT have improved survival compared to patients not receiving LRT. Additionally, for patients who did not undergo transplant survival is significantly longer for those receiving LRT.