Fluid-dynamic control microcatheter used with glue: preliminary experience on its feasibility and safety.

PURPOSE: To evaluate feasibility, safety, and success of peripheral embolization procedures carried out using anti-reflux microcatheter with N-butyl-cyanoacrylate (NBCA) as an embolic agent. METHODS: We retrospectively described 11 patients that suffered from active bleeding in different body districts, who underwent embolization procedure using SeQure microcatheter (Guerbet, France) with NBCA glue (Glubran II, GEM Italy) as an embolic agent. The treatments required NBCA volumes ranged from 0.1 to 0.6 mL, with different dilutions with ethiodized oil (Lipiodol, Guerbet, France), depending on the entity of the bleeding. Technical success, clinical success, and complications were evaluated. RESULTS: The procedures were successfully concluded in the totality of the patients, achieving full technical and clinical success. In one patient (9.1%), a small upstream of embolic material was encountered, without any consequence. CONCLUSION: This preliminary experience shows that the use of SeQure is feasible and safe with NBCA.

Outcomes following minimally invasive imagine-guided percutaneous ablation of adrenal glands.

Whilst surgery represents the gold standard for the treatment of adrenal primary malignant tumors, metastatic involvement of the adrenal glands is generally approached conservatively; however, surgery for local control has been controversial, and several reports have described the utility of surgical removal in terms of prolonged survival in selected patients. Different techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), laser induced thermal therapy (LITT), cryoablation (CRA), and chemical ablation, are employed in percutaneous image-guided ablation for primary and metastatic malignancies of the adrenal glands, in case of patients with multiple comorbidities or who refuse surgery. Technical success, clinical success and safety were analysed and discussed in this systematic review. Tumor size was found a significant determinant for local disease control; histology of the primary malignancy and coexistence of tumor elsewhere were correlated with prognosis. These procedures resulted to be feasible and safe, with hypertensive crisis representing the most common complication. Although there is lack of evidence in the literature concerning outcomes compared with surgery, percutaneous ablation may represent a useful therapeutic option for controlling unresectable adrenal metastases, offering patients opportunities for improved survival.

Gastric Cancer Staging: Is It Time for Magnetic Resonance Imaging?

Gastric cancer (GC) is a common cancer worldwide. Its incidence and mortality vary depending on geographic area, with the highest rates in Asian countries, particularly in China, Japan, and South Korea. Accurate imaging staging has become crucial for the application of various treatment strategies, especially for curative treatments in early stages. Unfortunately, most GCs are still diagnosed at an advanced stage, with the peritoneum (61-80%), distant lymph nodes (44-50%), and liver (26-38%) as the most common metastatic locations. Metastatic disease is limited to the peritoneum in 58% of cases; in nonperitoneal distant metastases, the most involved GC metastasization site is the liver (82%). The eighth edition of the tumor-node-metastasis staging system is the most commonly used system for determining GC prognosis. Endoscopic ultrasonography, computed tomography, and 18-fluorideoxyglucose positron emission tomography are historically the most accurate imaging techniques for GC staging. However, studies have recently shown renewed interest in magnetic resonance imaging (MRI) as a useful tool in GC staging, especially for distant metastasis assessment. The technical improvement of diffusion-weighted imaging and the increasing use of hepatobiliary contrast agents have been shown to increase the diagnostic performance of MRI, particularly for detecting peritoneal and liver metastasis. However, no principal oncological guidelines have included the use of MRI as a first-line technique for distant metastasis evaluation during the GC staging process, such as the National Comprehensive Cancer Network Guidelines. This review analyzed the role of the principal imaging techniques in GC diagnosis and staging, focusing on the potential role of MRI, especially for assessing peritoneal and liver metastases.

Microwave ablation of malignant renal tumours: intermediate-term results and usefulness of RENAL and mRENAL scores for predicting outcomes and complications.

The aim of this study was to evaluate intermediate-term results after microwave ablation (MWA) of renal tumours and determine the association of RENAL and modified RENAL (mRENAL) scores with oncological outcomes and complications. In May 2008-September 2014, 58 patients affected by early-stage RCC (renal cell carcinoma; T1a or T1b) were judged unsuitable for surgery and treated with percutaneous MWA. Follow-up was performed with contrast-enhanced computed tomography at 1, 3, 6, 12 and 24 months after the procedure. Technical success (TS), primary technical effectiveness (PTE), secondary technical effectiveness (STE), the local tumour progression rate (LTPR), the cancer-specific survival rate (CSSR), disease-free survival (DFS), overall survival (OS) and safety were recorded. All lesions were evaluated using RENAL and mRENAL scores, and complications were assessed with RENAL scores. The TS rate was 100%, PTE was 93%, STE was 100%, LTPR was 15.7% at 1 year, CSSR was 96.5%, DFS was 87.9% at 5 years, and OS was 80.6%. Mean follow-up was 25.7 months (range 3-72). The mean ± standard deviation (SD) RENAL and mRENAL scores of all treated tumours were 6.7 ± 2.05 (range 4-11) and 7 ± 2.3 (range 4-12), respectively. Major complications occurred in two (2/58) and minor complications in three patients (3/58). Overall complications correlated significantly with RENAL scores; in particular, E and L represent negative predictors for safety and effectiveness. MWA is a valuable alternative for treating RCCs. The correlation with outcomes and complications of RENAL and mRENAL scores could help to customise MWA indications in RCC patients.

Ultra-low profile polymer-filled stent graft for abdominal aortic aneurysm treatment: a two-year follow-up.

PURPOSE: This study evaluated 2 years of follow-up of the Ovation Abdominal Stent Graft System (TriVascular Inc., Santa Rosa, CA, USA) for endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs). MATERIALS AND METHODS: This retrospective multicentre study included 36 patients (median age, 73.6 year) with AAAs (mean diameter, 5.65 cm) treated with the Ovation stent graft and followed up for at least 2 years. Safety and effectiveness of the Ovation stent graft were evaluated. Indications for EVAR were the following: AAA ≥5 cm, neck length ≥7 mm, angulation ≤60° and diameter <30 mm; the presence of neck calcification and thrombosis was not considered a contraindication; distal iliac landing zone length of 10 mm, and diameter between 5 and 20 mm. Patients were treated under a common protocol, including clinical and imaging follow-up at discharge, 30 days, 6 months, and annually for 5 years. Adverse events, clinical and imaging data and possible re-intervention were recorded. RESULTS: The Ovation stent graft was implanted successfully in 36 patients (100 %). None of the patients required conversion to open surgery, and none presented with an aneurysm rupture. Endograft stent fracture or migration was not observed in any case. No type I, III or IV endoleaks were observed; in 12 patients (33.3 %), a type II endoleak was noted, in one case with sac enlargement but not treated due to concomitant comorbidities and the patient's decision. CONCLUSIONS: The 2-year results of the Ovation Abdominal Stent Graft System demonstrate excellent safety and effectiveness in the treatment of patients with AAAs, particularly in those with challenging anatomical characteristics.