Partial splenic embolization with embosphere microspheres (700-900 µm) for the treatment of hypersplenism: comparison of selective superior splenic artery embolization and inferior splenic artery embolization.

Objective: To compare clinical outcomes of superior versus inferior splenic artery embolization in partial splenic embolization (PSE) and identify predictors of major complications. Material and methods: This retrospective case-control study included 73 patients who underwent PSE between May 2005 and April 2021. They were divided into two groups: the superior and middle splenic artery embolization group (Group A, n = 37) and the inferior and middle splenic artery embolization group (Group B, n = 36). Outcome differences and major complications between the groups were assessed. Logistic regression was used to analyze potential predictors of major complications, and the optimal cutoff value for splenic embolization rates was determined using the Youden index. Results: There were no significant differences in laboratory and radiological outcomes between the two groups. Group A had a significantly lower incidence of major complications than Group B (p = 0.049), a lower Visual Analog Scale (VAS) score for pain (p = 0.036), and a shorter hospital stay (p = 0.022). Independent risk factors for major complications included inferior and middle splenic artery embolization (odds ratio [OR] = 3.672; 95% confidence interval [CI] = 1.028-13.120; p = 0.045) and a higher spleen embolization rate (OR = 1.108; 95% CI = 1.003-1.224; p = 0.044). The optimal cutoff for spleen embolization rate to predict major complications was 59.93% (sensitivity 77.8%, specificity 63.6%). Conclusion: Using 500-700 µm microspheres for PSE, targeting the middle and superior splenic artery yields similar effects to targeting the middle and inferior artery, but results in lower rates of major complications and shorter hospital stays. To effectively minimize the risk of major complications, the embolization rate should be kept below 59.93%, regardless of the target vessel.

Efficacy and predictive factors of transarterial chemoembolization combined with lenvatinib plus programmed cell death protein-1 inhibition for unresectable hepatocellular carcinoma.

BACKGROUND: The efficacy and safety of transarterial chemoembolization (TACE) combined with lenvatinib plus programmed cell death protein-1 (PD-1) for unresectable hepatocellular carcinoma (HCC) have rarely been evaluated and it is unknown which factors are related to efficacy. AIM: To evaluate the efficacy and independent predictive factors of TACE combined with lenvatinib plus PD-1 inhibitors for unresectable HCC. METHODS: This study retrospectively enrolled patients with unresectable HCC who received TACE/lenvatinib/PD-1 treatment between March 2019 and April 2022. Overall survival (OS) and progression-free survival (PFS) were determined. The objective response rate (ORR) and disease control rate (DCR) were evaluated in accordance with the modified Response Evaluation Criteria in Solid Tumors. Additionally, the prognostic factors affecting the clinical outcome were assessed. RESULTS: One hundred and two patients were enrolled with a median follow-up duration of 12.63 months. The median OS was 26.43 months (95%CI: 17.00-35.87), and the median PFS was 10.07 months (95%CI: 8.50-11.65). The ORR and DCR were 61.76% and 81.37%, respectively. The patients with Barcelona Clinic Liver Cancer Classification (BCLC) B stage, early neutrophil-to-lymphocyte ratio (NLR) response (decrease), or early alpha-fetoprotein (AFP) response (decrease > 20%) had superior OS and PFS than their counterparts. CONCLUSION: This study showed that TACE/lenvatinib/PD-1 treatment was well tolerated with encouraging efficacy in patients with unresectable HCC. The patients with BCLC B-stage disease with early NLR response (decrease) and early AFP response (decrease > 20%) may achieve better clinical outcomes with this triple therapy.

Targeted versus Empiric Embolization for Delayed Postpancreatectomy Hemorrhage: A Retrospective Study of 312 Patients.

PURPOSE: To assess the safety and clinical effectiveness of empiric embolization (EE) compared with targeted embolization (TE) in the treatment of delayed postpancreatectomy hemorrhage (PPH). MATERIALS AND METHODS: The data of patients with delayed PPH between January 2012 and August 2022 were analyzed retrospectively. In total, 312 consecutive patients (59.6 years ± 10.8; 239 men) were included. The group was stratified into 3 cohorts according to angiographic results and treatment strategies: TE group, EE group, and no embolization (NE) group. The χ2 or Fisher exact test was implemented for comparing the clinical success and 30-day mortality. The variables related to clinical failure and 30-day mortality were identified by univariable and multivariable analyses. RESULTS: Clinical success of transcatheter arterial embolization was achieved in 70.0% (170/243) of patients who underwent embolization. There was no statistical difference in clinical success and 30-day mortality between the EE and TE groups. Multivariate analyses demonstrated that malignant disease (odds ratio [OR] = 5.76), Grade C pancreatic fistula (OR = 7.59), intra-abdominal infection (OR = 2.54), and concurrent extraluminal and intraluminal hemorrhage (OR = 2.52) were risk factors for clinical failure. Moreover, 33 patients (13.6%) died within 30 days after embolization. Advanced age (OR = 2.59) and intra-abdominal infection (OR = 5.55) were identified as risk factors for 30-day mortality. CONCLUSIONS: EE is safe and as effective as TE in preventing rebleeding and mortality in patients with angiographically negative delayed PPH.

Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2022 Edition).

Background: Primary liver cancer, of which around 75-85% is hepatocellular carcinoma in China, is the fourth most common malignancy and the second leading cause of tumor-related death, thereby posing a significant threat to the life and health of the Chinese people. Summary: Since the publication of Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China in June 2017, which were updated by the National Health Commission in December 2019, additional high-quality evidence has emerged from researchers worldwide regarding the diagnosis, staging, and treatment of liver cancer, that requires the guidelines to be updated again. The new edition (2022 Edition) was written by more than 100 experts in the field of liver cancer in China, which not only reflects the real-world situation in China but also may reshape the nationwide diagnosis and treatment of liver cancer. Key Messages: The new guideline aims to encourage the implementation of evidence-based practice and improve the national average 5-year survival rate for patients with liver cancer, as proposed in the "Health China 2030 Blueprint."

Study on the driving mechanism of lagged effects based on different time scales in a karst drainage basin in South China.

Compared to earthquakes and volcanoes, drought is one of the most damaging natural disasters and is mainly affected by rainfall losses, especially by the runoff regulation ability of the underlying watershed surface. Based on monthly rainfall runoff data recorded from 1980 to 2020, in this study, the distributed lag regression model is used to simulate the rainfall-runoff process in the karst distribution region of South China, and a time series of watershed lagged-flow volumes is calculated. The watershed lagged effect is analyzed by four distribution models, and the joint probability between the lagged intensity and frequency is simulated by the copula function family. The results show that (1) the watershed lagged effects simulated by the normal, log-normal, P-III and log-logistic distribution models in the karst drainage basin are particularly significant, with small mean square errors (MSEs) and significant time-scale characteristics. (2) Affected by spatiotemporal distribution differences in rainfall and the impacts of different basin media and structures, the lag response of runoff to rainfall differs significantly among different time scales. Especially at the 1-, 3- and 12-month scales, the coefficient of variation (Cv) of the watershed lagged intensity is greater than 1, while it is less than 1 at the 6- and 9-month scales. (3) The lagged frequencies simulated by the log-normal, P-III and log-logistic distribution models are relatively high (with medium, medium-high and high frequencies, respectively), while that simulated by the normal distribution is relatively low (medium-low and low frequencies). (4) There is a significant negative correlation (R < - 0.8, Sig. < 0.01) between the watershed lagged intensity and frequency. For the joint probability simulation, the fitting effect of the gumbel Copula is the best, followed by the Clayton and Frank-1 copulas, and while that of the Frank-2 copula is relatively weak. Consequently, the propagation mechanism from meteorological drought to agricultural or hydrological drought and the conversion mechanism between agricultural and hydrological drought are effectively revealed in this study, thereby providing a scientific basis for the rational utilization of water resources and drought resistance and disaster relief in karst areas.

Establishment of hormone-induced canine benign prostatic hyperplasia model: A prospective, controlled study.

Purpose: To evaluate the feasibility of the establishment of a more efficient hormone-induced canine benign prostatic hyperplasia (BPH) model. Methods: This prospective pilot study included a total of 16 male beagle dogs who underwent dihydrotestosterone and ß-estradiol treatment after castration. They were randomly divided into three groups; eight beagles in group A with 1.0 ml hormone treatment, four beagles in group B with 0.8 ml hormone treatment, and four beagles in group C with 1.2 ml hormone treatment, each according to the table of random digit. The size of the prostate was measured using magnetic resonance imaging before and 4, 8, and 12 weeks after intramuscular injection of hormone drugs. Prostate size larger than 18 g was regarded as BPH in dogs. Results: Beagle dogs in all three groups were successfully modeled for BPH. The experimental group A (n = 8) was successfully modeled after 4 weeks of 1.0 ml hormone treatment, while the control group B (n = 4) was successfully modeled after 8 weeks of 0.8 ml hormone treatment, and the control group C (n = 4) was successfully modeled after 12 weeks of 1.2 ml hormone treatment. Conclusions: Appropriate dose of hormone can significantly shorten the time of successful establishment of canine BPH model, and an increase in hormone dosage can inhibit prostatic hyperplasia.

Safety and efficacy of transcatheter arterial embolization for management of refractory hematuria of prostatic origin.

Objective: To estimate the safety and efficacy of transcatheter arterial embolization (TAE) in the treatment of refractory hematuria of prostatic origin (RHPO). Methods: This retrospective study included 23 patients who underwent TAE for RHPO between May 2013 and August 2021. Technical and clinical success rates were calculated, and arteriogram findings and complications were detected. Results: Embolization was performed 24 times in 23 patients. Technical success was achieved in 24/24 (100%) embolization procedures. Contrast agent extravasation was detected during 2 of the 24 angiographic procedures. Bilateral embolization was performed in 23 (95.8%) of the 24 procedures. The clinical success rate was 21/23 (91.3%), and hematuria stopped 1-4 days after TAE. No serious complications were observed. Conclusion: TAE is a safe and effective minimally invasive technique for treating patients with RHPO.

Medium and Long-Term Outcome of Superselective Transcatheter Arterial Embolization with Lipiodol-Bleomycin Emulsion for Giant Hepatic Hemangiomas: Results in 241 Patients.

Purpose: To evaluate the medium and long-term efficacy of superselective transcatheter arterial embolization (TAE) with lipiodol−bleomycin emulsions (LBE) for giant hepatic hemangiomas. Methods: A total of 241 patients who had underwent TAE with LBE for hepatic hemangiomas from January 2010 to December 2016 were retrospectively reviewed. Blood tests were performed 3 and 7 days after TAE and procedural-related complications were recorded. The patients were followed up by enhanced CT or MRI imaging at 6, 12, 36, and 60 months post-TAE, respectively. Technical success of TAE was defined as successful embolization of all identifiable arteries supplying to the hemangiomas. Clinical success was defined as improvement of the abdominal symptoms and indications on the imaging examinations that the hemangiomas had decreased by more than 50% in maximum diameter. Results: TAE was performed successfully in all patients without serious complications. Improvement of the abdominal symptoms was recorded in 102/102 cases (100%). The reduction rate of the tumor maximum diameter with >50% at 6, 12, 36, and 60 months was 88.1% (190/210), 86.7% (170/196), 85.2% (124/142), and 86.5% (45/52), respectively. There was a significant change from pre-TAE to follow-up values in maximum diameter (p < 0.05). Conclusion: TAE with LBE was feasible and effective for giant hepatic hemangiomas. The reductions of the tumor maximum diameter with >50% at medium (≥3 years) and long-term (≥5 years) follow-up were satisfactory, with 85.2% and 86.5%, respectively.

Heparin-bonded stent graft placement for treatment of massive epistaxis from ruptured radiation-induced internal carotid artery pseudoaneurysm: A case report.

Rupture of an internal carotid artery (ICA) pseudoaneurysm is a rare but life-threatening complication of irradiation therapy for a nasopharyngeal carcinoma (NPC). A 36-year-old man had a history of NPC treated with radiotherapy 8 years previously. He was admitted to the hospital because of severe repetitive epistaxis with hemodynamically instablility. An emergent angiography showed the left ICA pseudoaneurysm at the petrous portion (C2 segment). The patient was successfully treated by a new-generation heparin-bonded stent graft without any complication. Emergent stent graft placement is effective in stopping hemorrhage and is therefore a life-saving intervention. Long-term follow-up is necessary to look out for delayed post-treatment complications.

Long noncoding RNA SNHG1 silencing accelerates hepatocyte-like cell differentiation of bone marrow-derived mesenchymal stem cells to alleviate cirrhosis via the microRNA-15a/SMURF1/UVRAG axis.

Bone marrow-derived mesenchymal stem cells (BMSCs) can differentiate into hepatocyte-like cells (HLCs) to attenuate cirrhosis. Long noncoding RNA (lncRNA) SNHG1 has been demonstrated to orchestrate BMSC differentiation, whereas its role in cirrhosis remains elusive. Therefore, this study was performed to figure out whether lncRNA SNHG1 was involved in cirrhosis by affecting HLC differentiation of BMSCs. Mouse BMSCs were isolated, and the BMSC differentiation into HLCs was induced by hepatocyte growth factor (HGF). A cirrhotic mouse model was established using carbon tetrachloride and phenobarbital, followed by intravenous injection of BMSCs with manipulated expression of lncRNA SNHG1, microRNA (miR)-15a, and SMURF1. Subsequent to HGF induction, expression of hepatocyte-related genes, albumin secretion, and glycogen accumulation was increased in BMSCs, suggesting the differentiation of BMSCs into HLCs. Mechanistically, lncRNA SNHG1 bound to miR-15a that targeted SMURF1, and SMURF1 diminished ATG5 and Wnt5a expression by enhancing the ubiquitination of UVRAG. LncRNA SNHG1 or SMURF1 silencing or miR-15a overexpression promoted differentiation of BMSCs into HLCs and repressed cirrhosis of mice by upregulating ATG5 and Wnt5a via UVRAG. Conclusively, lncRNA SNHG1 silencing might facilitate HLC differentiation from mouse BMSCs and alleviate cirrhosis via the miR-15a/SMURF1/UVRAG/ATG5/Wnt5a axis.

Comparison of long-term outcomes of balloon angioplasty with or without stent placement for hepatic vein type Budd-Chiari syndrome.

PURPOSE: To compare percutaneous transluminal balloon angioplasty (PTBA) alone with PTBA plus stent placement for Budd-Chiari syndrome (BCS) patients with short-segmental obstruction of hepatic vein. METHODS: Between May 2001 and December 2010, 91 hepatic vein type BCS patients (mean age, 32.8 ± 10.8; M:F ratio 50:41) were included and divided into two groups (PTBA alone, as group A, n = 48; PTBA plus stent, as group B, n = 43). The incidence of restenosis, long-term patency, and survival were evaluated. RESULTS: All 91 patients were successfully treated with hepatic vein recanalization. During follow-up period (median 161 months, range: 84-234), group B had a significantly higher proportion of hepatic vein restenosis (56%, 24/43) than group A (33%, 16/48; P < 0.05). Cumulative primary patency rates at 1, 5, 10, 15 years were 96%, 81%, 69%, 65% and 91%, 60%, 47%, 47% in group A and group B, respectively (log-rank P < 0.05). Secondary technical success rates of target hepatic vein were 93% and 57% in group A and group B, respectively (P < 0.05). Clinical complete response rates were 94% and 86% in group A and group B, respectively (P > 0.05). The 15-year cumulative survival rates were 98% and 95% in group A and group B, respectively (P > 0.05). Major procedure-related complications occurred in 3 (3%) patients (1 in group A, 2 in group B). CONCLUSIONS: Hepatic vein recanalization is safe and efficient for hepatic vein type BCS patients with hepatic vein short segmental obstruction. Restenosis after hepatic vein stenting is more common and difficult to manage than that after hepatic vein balloon angioplasty alone.

The outcomes of interventional treatment for Budd-Chiari Syndrome complicated by inferior vena cava thrombosis: Systematic review and meta-analysis / Resultados del tratamiento intervencionista del síndrome de Budd-Chiari agravado por trombosis de la vena cava inferior: Una revisión y un metaanálisis sistemáticos

Purpose: The aim of this study was to perform a systematic review and meta-analysis to assess the safety and efficacy of interventional treatment for Budd-Chiari syndrome (BCS) complicated by Inferior Vena Cava thrombosis (IVCT) patients. Methods: We evaluated the published studies on interventional treatment for BCS complicated by IVCT. Meta-analysis was used to calculate the combined effect size and their 95% confidence intervals (CI) based on random effect. The publication bias was assessed by Begg's test. Results: Sixteen studies on interventional treatment for BCS complicated by IVCT patient were selected for meta-analysis, a total of 767 BCS complicated by IVCT patients were included. The combined effect size (95% CI) were 99% (98–100%) for the total successful rate of IVC recanalization, 15% (11–21%) for the rate of IVC restenosis after initial operation, 92.0% (86–97%) for the rate of clinical improvement, 76% (68–84%) for the rate of thrombus clearance and 0.00% (0–1%) for the incidence of pulmonary embolism (PE). Through subgroup meta-analysis about the rate of thrombus clearance, we got the pooled results (95% CI) of individualized treatment strategy (ITS) group and non-individualized treatment strategy (non-ITS) group, were 81% (71–92%) and 73% (63–83%), respectively. Conclusions: The interventional treatment for BCS complicated by IVCT patients is safe and effective with low incidence of PE, high thrombus clearance rate, high technically successful rate, good patency, and high clinical improvement rate. Moreover, subgroup analysis indicated that management based on the type and extent of the thrombus is proposed.(AU)

Objetivo: El objetivo de este estudio fue realizar una revisión y un metaanálisis sistemáticos para evaluar la seguridad y la eficacia del tratamiento intervencionista en los pacientes con el síndrome de Budd-Chiari (SBC), agravado por trombosis de la vena cava inferior (TVCI). Métodos: Evaluamos los estudios publicados sobre el tratamiento intervencionista del SBC agravado por TVCI. Se utilizó el metaanálisis para calcular el tamaño del efecto combinado y los intervalos de confianza (IC) del 95%, basados en el efecto aleatorio. El sesgo de publicación se evaluó con la prueba de Begg. Resultados: Para el metaanálisis se seleccionaron 16 estudios sobre el tratamiento intervencionista de pacientes con SBC agravado por TVCI; se incluyó un total de 767 pacientes con SBC agravado por TVCI. El tamaño del efecto combinado (IC del 95%) fue del 99% (98-100%) para la tasa de éxito global de la recanalización de la vena cava inferior (VCI), un 15% (11-21%) para la tasa de reestenosis de la VCI después de la operación inicial, un 92% (86-97%) para la tasa de mejora clínica, un 76% (68-84%) para la tasa de eliminación de trombos y un 0% (0-1%) para la incidencia de embolia pulmonar. En el metaanálisis de subgrupos de la tasa de eliminación de trombos, los resultados combinados (IC del 95%) para el grupo de estrategia de tratamiento individualizado y el grupo de estrategia de tratamiento no individualizado fueron del 81% (71-92%) y del 73% (63-83%), respectivamente. Conclusiones: El tratamiento intervencionista de pacientes con SBC agravado por TVCI es seguro y eficaz, con una baja incidencia de embolia pulmonar, una alta tasa de eliminación de trombos, una alta tasa de éxito técnico, una buena permeabilidad y una tasa elevada de mejora clínica. Además, el análisis de subgrupos reveló que el mejor enfoque es el tratamiento basado en el tipo y la extensión del trombo.(AU)

Efficacy and Safety of Surgical Ligation versus Endovascular Embolization for Type II Congenital Extrahepatic Portosystemic Shunt.

OBJECTIVE: To evaluate the safety and efficacy of surgical ligation and endovascular embolization for the treatment of type II congenital extrahepatic portosystemic shunt (CEPS). METHODS: In this retrospective study, 23 patients diagnosed with type II CEPS between March 2011 and April 2019 were divided into either a surgical group (n = 13; 41.5 ± 19.9 years) or the interventional group (n = 10; 44.9 ± 19.7 years). The surgical group underwent laparoscopic surgical ligation of the shunt alone or ligation of the shunt and splenic artery and/or vein. The interventional group underwent endovascular embolization using microcoils, detachable coils, and vascular plug. RESULTS: All 23 patients received a one-step shunt closure, and their clinical symptoms were significantly improved within 3-month postprocedure and without recurrence during follow-up. The serum ammonia levels in both groups decreased after the procedure and dropped to normal level at 6- to 12-month postprocedure. Compared with baseline, the portal vein diameter in interventional group increased significantly at 3-, 6-, 12-, and 36-month postocclusion (P = 0.01 for all). The procedure time was shorter in the interventional group (127.0 ± 43.2 minutes) than the surgical group (219.8 ± 56.7 minutes; P < 0.001). The intraoperative blood loss in the interventional group (32.0 ± 62.5 mL) was less than that in the surgical group (238.5 ± 396.9 mL; P = 0.001). CONCLUSION: Both surgical ligation and endovascular embolization are effective in the treatment of type II CEPS. Endovascular embolization has the advantages of shorter procedure time and less intraoperative blood loss. The ligation of the portosystemic shunt and splenic artery and vein is feasible with apparent safety, and it could avoid a second surgical treatment.

Long-term outcomes of individualized interventional treatment for primary Budd-Chiari syndrome complicated by inferior vena cava thrombosis.

BACKGROUND: Various endovascular treatments were used for Budd-Chiari syndrome (BCS) patients complicated by inferior vena cava (IVC) thrombosis. The best treatment for this disease remains unknown. To evaluate safety and efficacy of individualized interventional treatment for primary BCS with IVC thrombosis. METHODS: Forty-seven consecutive patients with IVC involvement BCS complicated by IVC thrombosis between June 2002 and August 2020 were analyzed retrospectively. They were treated with individualized interventional treatment based on thrombus type and size. Agitation thrombolysis, transcatheter thrombus aspiration, and catheter-directed thrombolysis were initially used for fresh and mixed thrombus (n = 20), then stent implantation for compressing thrombus and IVC recanalization were performed according to the size of the residual thrombus. Direct balloon angioplasty was used for old thrombus (n = 27). RESULTS: Median follow-up duration was 109 (5-223) months (average 114 ± 60 months). IVC recanalization were attempted in forty patients and failed in one. The technical successful rate of IVC recanalization was 97.5%. Thrombus was completely lysed in eight patients with fresh thrombus (40%, 8/20), partially lysed in 11 patients with mixed thrombus (55%, 11/20), and no response in one patient with mixed thrombus (5%, 1/20). Thrombolytic-related complications occurred in one patient (5%, 1/20). No symptomatic pulmonary embolism occurred. Among the 11 patients with thrombus partially lysed, five patients underwent stent implantation for compressing thrombus, six patients received conservative treatment. Old thrombus was completely lysed in 15 patients (55.6%, 15/27) during follow-up. Restenosis occurred in six patients (15.4%, 6/39). Primary patency rates at 1, 5, 10 and 15 years were 92, 92, 86 and 80%, respectively. Hepatocellular carcinoma (HCC) occurred in four patients (8.5%, 4/47). One patient died of HCC. The survival rate was 97.9%. CONCLUSIONS: The individualized interventional treatment based on thrombus type and size for primary BCS complicated by IVC thrombosis patients is safe and effective with long-term patency and survival.

Restenosis after Balloon Dilatation with versus without Stent Placement for Hepatic Vein Involvement Budd-Chiari Syndrome.

Balloon angioplasty with or without stent placement has become the mainstream treatment of Budd-Chiari syndrome (BCS). Restenosis of hepatic vein (HV) is a tough problem. The aim of this study was to perform a meta-analysis to compare the restenosis in HV involvement type BCS patients treated by balloon dilatation with versus without stent. Meta-analysis was used to calculate the combined effect size and their 95% confidence intervals (CI), based on random effect; and calculate the risk ratio (RR) and its 95% CI based on fixed effect. The publication bias was assessed by funnel plot and Begg's test. Sixteen studies were selected for meta-analysis. One thousand and eighty-two patients (1,019 from Asian, 63 from non-Asian countries) were included. Seven hundred and five of 1,019 (69%) Asian patients received HV balloon dilatation alone. RR value (RR=0.85, 95% CI 0.68-1.08) of the two groups was obtained through meta-analysis, which meant that the risk of restenosis in balloon dilatation alone group was 15% lower than that in combined with stent placement group; although there was no significant statistical difference between two groups (p=0.178). The current meta-analysis indicated that balloon dilatation alone is first preferred approach in Asian BCS patients compared to the non-Asian patients. Balloon dilatation combined with stent placement does not reduce restenosis risk over balloon dilation alone in the treatment of BCS with HV occlusion. It is suggested that stent should be used cautiously for such patients. Key Words: Balloon dilatation, Budd-Chiari syndrome, Stent, Restenosis, Meta-analysis.

The outcomes of interventional treatment for Budd-Chiari Syndrome complicated by inferior vena cava thrombosis: Systematic review and meta-analysis.

PURPOSE: The aim of this study was to perform a systematic review and meta-analysis to assess the safety and efficacy of interventional treatment for Budd-Chiari syndrome (BCS) complicated by Inferior Vena Cava thrombosis (IVCT) patients. METHODS: We evaluated the published studies on interventional treatment for BCS complicated by IVCT. Meta-analysis was used to calculate the combined effect size and their 95% confidence intervals (CI) based on random effect. The publication bias was assessed by Begg's test. RESULTS: Sixteen studies on interventional treatment for BCS complicated by IVCT patient were selected for meta-analysis, a total of 767 BCS complicated by IVCT patients were included. The combined effect size (95% CI) were 99% (98-100%) for the total successful rate of IVC recanalization, 15% (11-21%) for the rate of IVC restenosis after initial operation, 92.0% (86-97%) for the rate of clinical improvement, 76% (68-84%) for the rate of thrombus clearance and 0.00% (0-1%) for the incidence of pulmonary embolism (PE). Through subgroup meta-analysis about the rate of thrombus clearance, we got the pooled results (95% CI) of individualized treatment strategy (ITS) group and non-individualized treatment strategy (non-ITS) group, were 81% (71-92%) and 73% (63-83%), respectively. CONCLUSIONS: The interventional treatment for BCS complicated by IVCT patients is safe and effective with low incidence of PE, high thrombus clearance rate, high technically successful rate, good patency, and high clinical improvement rate. Moreover, subgroup analysis indicated that management based on the type and extent of the thrombus is proposed.

Postpancreatectomy hemorrhage with negative angiographic findings: outcomes of empiric embolization compared to conservative management.

OBJECTIVE: To evaluate the efficacy of empiric embolization for postpancreatectomy hemorrhage (PPH) with negative angiographic signs of active bleeding. MATERIALS AND METHODS: A total of 100 patients (76 men, 24 women) who were diagnosed with PPH with angiographic findings revealing no signs of active bleeding from December 2013 to December 2019 were included in the study. The patients were divided into two groups according to whether the procedures were performed with or without empiric embolization in angiography (group of empiric embolization, N=47; group of no embolization, N=53). Data reflecting patients' characteristics, hemorrhagic details, classification of PPH grade, and postoperative complications were acquired. The rates of clinical success in hemostasis and mortality were compared between the group of empiric embolization and the group of no embolization. RESULTS: In the group of empiric embolization, the rate of clinical success in hemostasis and mortality were 61.7% and 27.7%, respectively. In the group of no embolization, the rates of clinical success in hemostasis and mortality were 39.6% and 13.2%, respectively. The rate of clinical success in hemostasis in the group of empiric embolization was significantly higher than that in the group of no embolization (p = 0.028). There was no statistically significant difference in mortality between the different groups (p = 0.071). CONCLUSION: The clinical success rate of hemostasis in patients with empiric embolization is higher than that in patients with no embolization. Empiric embolization may be an efficacious hemostatic treatment for PPH with angiographic findings revealing no signs of active bleeding.

Simultaneous transarterial chemoembolization and radiofrequency ablation for large hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is a common cancer and a leading cause of tumor-related death. Patients with large HCC (≥ 8 cm) are at an advanced stage and have poor prognosis, and hepatic resection may not be suitable, and the incidence of postoperative recurrence is high. AIM: To evaluate recurrence and mid-term survival of patients with large HCC treated by transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA). METHODS: This was a retrospective study. From 2010 to 2013, 46 consecutive patients with large HCC were treated with simultaneous TACE and RFA. Thirty-five of 46 patients had a single tumor. Progression-free survival (PFS) and overall survival (OS) were analyzed at 2 years and 3 years, respectively. RESULTS: Forty-six patients treated by simultaneous TACE and RFA had no significant complications and treatment was successful. After 3 years, median PFS and OS were 10.21 ± 1.58 mo and 26.44 ± 2.26 mo, retrospectively. The survival rate was 67.5% after 2 years and 55.67% after 3 years. CONCLUSION: These preliminary data show that simultaneous TACE and RFA are safe and effective for large HCC.

General versus local anesthesia for percutaneous radiofrequency ablation of hepatocellular carcinoma at unusual regions.

AIMS: The aim of this study is to compare the efficacy and safety of percutaneous radiofrequency ablation (RFA) under general anesthesia or local anesthesia plus intraoperative analgesia in the treatment of hepatocellular carcinoma (HCC) at unusual regions. SUBJECTS AND METHODS: From July 2012 to October 2019, 83 consecutive patients with 107 HCC lesions were treated with interventional radiology therapy. The lesions were located at some unusual regions such as diaphragmatic surface, hepatic hilum, hepatic subcapsular region, tissues near inferior vena cava, and tissues near the colon. General anesthesia was applied in 57 cases (general anesthesia group) and local anesthesia plus intraoperative analgesia was used in 26 cases (local anesthesia group). All patients were treated with transcatheter arterial chemoembolization, followed immediately by RFA. The rate of tumor inactivation, time used for placing RF needles to the scheduled sites, pain score, and complications were analyzed. STATISTICAL ANALYSIS USED: All continuous variables were tested for the normal/nonnormal distribution by Kolmogorov-Smirnov test. The t-test was used to analyze the normal distribution variables; the Mann-Whitney U-test was used to measure nonnormal distribution variables; and the Chi-square test for categorical variables. P < 0.05 was considered statistically significant. RESULTS: The treatments were successful in all patients, including 51 cases of complete response (CR) and 6 cases of partial response (PR) in the general anesthesia group and 18 cases of CR and 8 cases of PR in the local anesthesia group (P = 0.049). The time used for placing the needles to the scheduled sites was 1-5 min (mean 2 min) in the general anesthesia group and 2-9 min (mean 4 min) in the local analgesia group (P < 0.001). The pain scores ranged from 0 to 2 points (mean 1 point) in the general anesthesia group and 2-9 points (mean 5 points) in the local anesthesia group (P < 0.001). With regard to complications, seven cases had pneumothorax and four cases had slight hepatic subcapsular hemorrhage in the general anesthesia group and four cases of pneumothorax and three cases of slight hepatic subcapsular hemorrhage in the local anesthesia group, and the difference was not statistically significant between the two groups (P = 0.715). CONCLUSIONS: For HCC located at unusual regions, general anesthesia is superior to local anesthesia plus intraoperative analgesia in percutaneous RFA in reducing the difficulty of the procedure and improving the safety of RFA.