Using a Catheter for Hemodialysis Placed in the Inferior Vena Cava for the First Time in N. Macedonia - Translumbar Approach.

Maintenance of vascular access for hemodialysis remains a challenge for every doctor. Exhausted conventional vascular access is the cause for the placement of the central venous catheter in unconventional sites such as enlarged collateral vessels, hepatic veins, hemiazygos, azygos, renal veins, and the inferior vena cava. The percutaneous translumbar catheter for hemodialysis in the inferior vena cava was described over 20 years ago. In this article, we report on the procedure and complications arising from the percutaneous translumbar approach of a hemodialysis catheter. This was done for the first time in N. Macedonia. This approach is a potential option in adults and children when conventional approaches are limited.

Safety, Feasibility and Technical Considerations from a Prospective, Observational Study-CIREL: Irinotecan-TACE for CRLM in 152 Patients.

CIREL, a prospective, Europe-wide, observational study aimed to assess the real-world feasibility and tolerability of irinotecan-based transarterial chemoembolization (LP-irinotecan TACE) for unresectable colorectal cancer liver metastases with regard to the treatment plan and adverse events (AEs). CIREL enrolled 152 eligible patients (≥18 years) with liver-only or dominant metastases treated with LP-irinotecan TACE following a multidisciplinary tumor board decision. Data were prospectively collected for baseline, the number of planned and performed sessions, and technical information and safety according to CTCAE 4.03/5.0. Results from 351 analyzed treatment sessions showed technical success for 99% of sessions, and 121 patients (79%) completed all planned sessions. Further, 60% of sessions were performed using opioids, 4% intra-arterial anesthetics, and 25% both. Additionally, 60% of patients experienced at least one peri-interventional AE of any grade; 8% of grade 3−4. Occurrence of AEs was related to larger liver-involvement (p < 0.001), bi-lobar disease (p = 0.002), and larger beads (p < 0.001). Using corticosteroids together with antiemetics showed reduced and lower grade vomiting (p = 0.01). LP-irinotecan TACE was tolerated well and had a high proportion of completed treatment plans. This minimally invasive locoregional treatment can be used together with concomitant systemic therapy or ablation.

Single-center randomized trial comparing conventional chemoembolization versus doxorubicin-loaded polyethylene glycol microspheres for early- and intermediate-stage hepatocellular carcinoma.

According to Barcelona Clinic Liver Cancer classification, transarterial chemoembolization (TACE) is preferred treatment for stage B and in certain cases for stage A hepatocellular carcinoma (HCC). Conventional TACE (c-TACE) and drug-eluting microspheres TACE (DEM-TACE) are available intraarterial therapies. Screening of patients with cirrhosis is of great importance for early detection of malignant liver nodules. Primary endpoint of this study was to compare DEM-TACE with c-TACE in terms of 12- and 24-month survival. Secondary endpoints were comparison of intensity and duration of the postembolization syndrome (PES) and severe adverse events. We randomized 60 patients with unresectable HCC one-to-one with c-TACE or DEM-TACE and followed them for at least 24 months or until death. TACE was repeated 'on-demand. Most patients underwent two TACE sessions and the median hospital stay was 3 days for c-TACE and 2 days for DEM-TACE group. The overall 12- and 24-month survival rates were 89.8 and 70.7%, respectively, precisely 85.7 and 63.6% after c-TACE and 90.2 and 75.8% after DEM-TACE, without any significant difference (P = 0.18). Median overall survival was 21.1 months. Significant difference in the overall 12- and 24-month survival was found in patients with Child-Pugh A compared to Child-Pugh B class (P = 0.001). Child-Pugh class, aspartate aminotransferase levels and ascites independently predicted survival (P = 0.003). Both, DEM-TACE and c-TACE showed excellent 12- and 24-month survival rates. No significant difference in terms of adverse events was found. PES was slightly more severe after c-TACE, because of elevated temperature. DEM-TACE requires shorter in-hospital stay.

Uterine Fibroid Embolization via Transradial versus Transfemoral Arterial Access: Technical Results.

AIM: This study was designed to compare the safety and feasibility of uterine fibroid embolisation (UFE) via transradial access (TRA) and transfemoral access (TFA). MATERIAL AND METHODS: A retrospective analysis was conducted for 2 cohorts: 13 cases with already established TFA (from February 2016 to September 2018) and the first 11 procedures performed via TRA (from October 2017 to October 2018). Indications for embolization included: heavy menstrual bleedings (n = 18), lower urinary tract symptoms (n = 2), pelvic pain (n = 3) and abdominal pain (n = 1). One interventional radiologist and one fellow performed all procedures at one institution. Technical success, procedural time, access site complications as well as feedback from patients were assessed for analysis. RESULTS: Technical success was achieved in 24/24 cases (100%). Unilateral uterine artery embolisation was performed in 7 cases (29.1%) and bilateral in 17 cases (70.8%). Mean procedure time was 72.4 minutes in TFA group, and 60.3 minutes in the TRA group. Mean fluoroscopy time was 25.3 minutes in the TFA group and 21.1 minutes in the TRA group. Access site-related and overall adverse events did not vary significantly among the study cohorts. CONCLUSIONS: TRA represents a safe and feasible approach for UFE with a comparable safety profile to TFA.

Successful Endovascular Treatment of a Giant Hepatic Artery Aneurysm with Dual Layer Stents Placement as Flow-Diverting Option: Case Report.

BACKGROUND: Visceral artery aneurysms are rare conditions. The incidence of hepatic artery aneurysm (HAA) accounts for approximately 20% of all splanchnic aneurysms. HAA can become a life-threatening situation because there is a great risk of rupture when it grows more than 2 cm in diameter. CASE PRESENTATION: In this article, we describe a case of a 54-year-old female patient with large hepatic artery aneurysm which was incidentally founded. From symptoms, she had abdominal discomfort slightly worsening after meals, frequent pain in mesogastrium and reported some unexplained weight loss in the last few months. The lesion was detected by CT examination of the abdomen and pelvis. CONCLUSION: The aneurysm was successfully treated at our department with the endovascular approach, by covering the aneurysmal sac with two stents, one closed cell and one double-layer micromesh new generation stent as a flow diverting option..

Safety Profile and Efficacy of Chemoembolization with Doxorubicin - Loaded Polyethylene Glycol Microspheres in Patients with Hepatocellular Carcinoma.

AIM: This study was designed as a preliminary investigation of safety and efficacy of LifePearl, polyethylene glycol microspheres loaded with doxorubicin for treatment of locally untreatable (i.e., unresectable and not suitable for local thermal ablation) hepatocellular carcinoma (HCC). MATERIAL AND METHODS: Patients with locally untreatable HCC (mono- or bilobar disease, ECOG performance status 0-1, Chilg-Pugh score < 11) were analysed for this single arm Unicenter retrospective study. All the information were acquired through our local hospital information system. DEB-TACE was performed with 100-200 microns LifePearl loaded with 75-150 mg of doxorubicin depending on tumour size. One interventional radiologist with experience of more than 350 TACE procedures and one fellow in radiology performed all embolisations. RESULTS: Twenty subjects with 29 tumours were treated (mean age 66.2 years). Child-Pugh status was A for 12 pts. (60%), B for 6 pts. (30%) and C for 2 pts. (10%). Three patients had insignificant ascites. Most patients (70%) underwent < 3 DEB-TACE procedures. Average doxorubicin dose was 71.1 mg per procedure. One patient had procedure-related SAE (acute pancreatitis) within the postembolization period which was induced due to non-target embolisation of the superior pancreaticoduodenal artery. Six-month freedom from procedure-related SAE or death was 95% (one necrotizing pancreatitis). Tumor response or stable disease was achieved in 95% (19/20) of subjects. Freedom from tumor progression or death at 6 months was 95%. One-year survival rate was 90% overall. CONCLUSION: The results from this investigation suggest that LifePearl microspheres, Terumo loaded with doxorubicin can provide an excellent local tumour control with very few side effects in a relatively homogeneous group of patients with locally untreatable HCC.