The Utility of Ultrasound Guidance to Improve the Safety of Closure of Antegrade Common Femoral Artery Access after Lower Limb Revascularization.

This study aimed to investigate the feasibility of ultrasound (US)-guidance in reducing adverse event (AE) rates when using Angioseal device during antegrade lower limb angioplasty via common femoral artery access. From December 2016 to November 2022, 1,322 patients were identified, including 1,131 (85.6%) patients who underwent US-guided closure and 191 (14.4%) who underwent non-US-guided closure. Moderate AEs were encountered in 10 (5.2%) patients in the non-US-guided closure group compared to 38 (3.4%) patients in the US-guided closure group (P = .208). Severe AEs were encountered in 4 (2.1%) patients in the non-US-guided closure group compared to 3 (0.3%) patients in the US-guided closure group (P = .010). Overall AEs occurred in 14 (7.3%) patients in the non-US-guided closure group compared to 41 (3.6%) patients in the US-guided closure group (P = .029). Binary logistic regression showed that only non-US guidance was an independent risk factor for the occurrence of severe AEs (P = .008).

Safety of loncastuximab tesirine-lpyl in diffuse large B-cell lymphoma with severe hepatic dysfunction.

Diffuse large B-cell lymphoma (DLBCL) is an aggressive subtype of non-Hodgkin lymphoma with a high rate of disease relapse despite the achievement of clinical responses to frontline chemoimmunotherapy treatments. Loncastuximab tesirine-lpyl is a novel anti-CD19 antibody conjugated to an alkylating pyrrolobenzodiazepine agent (SG3199), and it has been approved for relapsed/refractory (r/r) DLBCL. Baseline moderate to severe hepatic impairment has an unclear impact on the safety of loncastuximab tesirine-lpyl, and there is a lack of clear guidance on dose adjustment from the manufacturer. The authors present two cases of r/r DLBCL safely treated with full-dose loncastuximab tesirine-lpyl in the setting of severe hepatic dysfunction.

Single-centre experience with endovascular rotational thrombectomy for single session salvage of thrombosed arteriovenous fistulas and grafts.

OBJECTIVES: This paper documents our experience and outcomes of using a relatively new endovascular rotational thrombectomy device for salvage of thrombosed vascular access. METHODOLOGY: A retrospective study reviewing patients with thrombosed native AVF or AVG who underwent endovascular declotting using a rotational thrombectomy device between November 2018 and May 2020 at a tertiary university hospital in Southeast Asia. We evaluated demographics, procedural data, technical and procedural success, patency rates and complications. RESULTS: A total of 40 patients underwent single session endovascular declotting of thrombosed vascular access. The mean follow-up period was 21.6 months (range 13.4-31 months). The technical success was 92.5% and clinical success was 80%. About 50% of patients had concomitant thrombolysis for pharmacomechanical thrombectomy. One patient had a myocardial infarction during the post-operative period. There were no other major complications within 30 days. The primary patency was 45.5% at 6 months and 22.7% at 12 months. Assisted primary patency was 68.1% at 6 months and 61.6% at 12 months, which was maintained up to 2 years. The secondary patency was 84.1% at 6 and 12 months. CONCLUSION: Our study shows that rotational thrombectomy device for single session thrombectomy of thrombosed arteriovenous fistulas and grafts is safe and effective. A high technical and clinical success rate was achieved, with low complication rates and specific advantages compared to other techniques, including reduced length of hospital stay. Our reported mid-term outcomes are reasonable with an assisted primary patency of 62% at 12 and 24 months. The use of newer techniques and novel dedicated thrombectomy devices show promise.

Technical Aspects of Percutaneous Deep Venous Arterialization Using Off-the-Shelf Devices.

PURPOSE: Chronic limb-threatening ischemia (CLTI) represents the clinical end stage of lower extremity peripheral arterial disease (PAD). Although conventional open and endovascular revascularization options are available, some CLTI patients do not respond to these treatments, generally due to small vessel occlusive disease, with only limited or no clinical improvement achieved. This article aims to provide insights related to pertinent venous anatomy of the leg and below the ankle and a technical review of percutaneous deep venous arterialization (pDVA) creation using commonly-available devices. TECHNIQUE: For patients with "no-option" CLTI, the risk of major amputation and mortality remains high. Although arterial revascularization remains the optimal treatment of CLTI, some patients with severely-diseased or gracile distal arteries have poor outcome. Deep venous arterialization (DVA), in a subset of patients with tibial anatomy amenable to DVA creation, represents the last-ditch attempt before these patients are deemed to have "no-hope" at limb salvage, and major amputation becomes necessary. Refinement in technique and advancement in device development have been shown to allow pDVA to be created with respectable outcomes for the "no-option" CLTI patient population. CONCLUSION: The pDVA has garnered increasing interest among endovascular specialists to further understand the anatomical and technical key points of this procedure, and it may yet prove to be a useful addition in the armamentarium in our battle against CLTI. CLINICAL IMPACT: Percutaneous deep venous arterialisation provides another option in the treatment of challenging "no-option" CLTI patients, and off-the-shelf devices will allow this procedure to be performed in centers where dedicated devices are not available.

Intravascular ultrasound correlation of unenhanced magnetic resonance venography in the context of pelvic deep venous disease.

OBJECTIVE: In the present retrospective, assessor-blinded cross-sectional study, we compared the diagnostic efficacy of the relaxation-enhanced angiography without contrast and triggering (REACT) protocol for magnetic resonance venography (MRV) and intravascular ultrasound (IVUS). METHODS: All patients without prior lower limb vascular stenting who had undergone MRV with the REACT protocol and IVUS at our institution from January 2018 to May 2020 were included. The REACT protocol for MRV comprises three main phases: the adiabatic-based T2-preparation module, the non-volume-selective short tau inversion recovery pulse sequence, and the three-dimensional, modified two-point chemical-shift water-fat separated turbo-field echo pulse sequence. The IVUS findings served as the reference standard for stenosis and were used in the diagnostic efficacy analysis of the REACT protocol for MRV. The REACT protocol MRV images were reviewed by three board-certified interventional radiologists, and an interrater analysis was performed. RESULTS: A total of 33 patients (110 segments with IVUS correlation; 18 men [54.5%] and 15 women [45.5%]) were included. Most patients were Chinese (63.6%), and 24 had had bilateral deep venous disease (72.7%). The mean patient age was 59.0 years (range, 26.0-79.5 years). Moderate agreement was found between the three radiologists' diagnoses of iliac vein pathology using the REACT protocol for MRV (κ = 0.524; 95% confidence interval [CI], 0.426-0.623; P < .001). Compared with IVUS, REACT protocol MRV achieved a sensitivity of 96.10% (95% CI, 89.03%-99.19%), specificity of 78.79% (95% CI, 61.09%-91.02%), positive predictive value of 91.36% (95% CI, 84.54%-95.33%), and negative predictive value of 89.66% (95% CI, 73.81%-96.38%). Overall, 78.5% agreement was noted between the REACT protocol MRV and IVUS findings. Good agreement between the index test and reference standard was noted (κ = 0.779; 95% CI, 0.645-0.907; P ≤ .05). CONCLUSIONS: REACT protocol MRV has the potential to be a highly sensitive and specific screening tool to diagnose deep venous disease.

Combined Biopsy and Imaging-Guided Microwave Ablation by Using a Coaxial Guiding Needle.

This article demonstrates the technique of using a coaxial guiding needle to perform combined percutaneous biopsy and microwave ablation via a single tract. From May 2019 to July 2020, 14 patients underwent combined biopsy and microwave ablation by using a coaxial guiding cannula. Tumors were in the kidney of six patients (43%), the liver of six patients (43%), and the lung in two patients (14%). The diagnostic yield of biopsy was 86% (12/14). Ablation technical success rate was 100%. In conclusion, using a coaxial guiding needle in microwave ablation and biopsy is safe and effective.

Single-Setting Superior Vena Cava Biopsy and Stenting Utilizing Cone Beam Computed Tomography as an Additional Tool.

BACKGROUND Malignant disease is a common etiology of superior vena cava syndrome (SVCS). Being a medical emergency, it often requires rapid diagnostic evaluation and therapy. Transcaval biopsy and endovascular stenting in a single-setting has been described, but only in a handful of cases. These cases utilized intra-operative venograms. In this study, we also used intra-operative cone beam computed tomography (CBCT) to increase the safety and efficacy of such single-setting procedures. CASE REPORT From January 2017 to July 2019, there were 5 patients with malignant SVCS who underwent single-setting superior vena cava biopsy and endovascular stenting utilizing intra-operative CBCT as an adjunct. Demographic data, clinical presentation, investigation results, procedural details, and patient outcomes were recorded. CBCT was utilized in all cases to optimize sampling of biopsies, visualize subsequent stent positioning, and for early detection of procedure-related complications. Transcaval biopsy was diagnostic in 4 of the 5 patients. Endovascular stents were deployed successfully in all cases, with post-stenting venogram demonstrating relief of prior obstructed segments. One patient had a complication of an apical pneumothorax, with no associated long-term pneumothorax-related morbidity or mortality. CONCLUSIONS This study demonstrates that single-setting transcaval biopsy and stenting in the context of malignant SVCS is a cost-efficient, safe, and feasible approach. In addition, the additional use of intra-operative CBCT is a useful tool to increase procedure efficacy and safety.

Ilio-Femoral Deep Vein Thrombosis Secondary to May-Thurner Syndrome With Ipsilateral Lower Limb Arterio-Venous Graft In-Situ.

Ilio-femoral deep vein thrombosis (DVT) is rare in patients with lower limb arterio-venous grafts due to a state of high blood flow. May-Thurner syndrome (MTS) is an anomaly where the left common iliac vein is compressed by the right common iliac artery. We present a rare case of ilio-femoral deep vein thrombosis in a patient with May-Thurner Syndrome and an underlying arteriovenous graft in-situ who presented with acute lower limb swelling. The patient underwent catheter-directed thrombolysis, pharmaco-mechanical thrombectomy, venoplasty and iliac vein stenting. Follow-up surveillance duplex ultrasound showed patency of the iliac vein stent and arteriovenous graft at 1-year postoperatively.

Iliac vein pathology and short-term stenting outcomes in a South-East Asian population: A single-centre experience.

OBJECTIVE: Current literature regarding iliofemoral intervention and stenting is mostly based on Western populations. We present our experience of iliofemoral stenting for chronic venous disease within a South-East Asian population. METHODS: This is a single-centre retrospective review of a prospectively collected registry. Seventy-one patients with 105 limbs underwent iliac vein IVUS and stenting between 2016 and 2019. All patients underwent pre-procedure ultrasound venous scan and MRI venogram. Pre- and post-operative CEAP classification, Villalta score and Venous Clinical Severity Score (VCSS), technical results, stent patency rates and complication rates are documented. RESULTS: Seventy-six per cent of the cases are non-thrombotic iliac vein lesion, and 68% of patients have C4 to C6 disease. Ten percentage of patients had acute thrombosis on presentation. There was 100% technical success. A 6- and 7-point reduction in the mean VCSS and Villalta score, respectively, were noted post-stenting (baseline of 10 points and P < 0.001 in both categories). Post-stenting ulcer healing rate was 91% at 6 and 12 months. One-year ulcer recurrence and cellulites recurrence were at 8% and 7%, respectively. One unplanned 30-day readmission (not related to procedure) and no 30-day mortality were noted. Bleeding complication from anticoagulation was 3%. There was 10% in-stent non-flow limiting stenosis on surveillance. One-year primary patency was 91%, and secondary patency was 100%. CONCLUSION: Within our series, iliofemoral stenting has 100% technical success, with statistically significant reduction in VCSS and Villalta score, good wound healing rates, low ulcer and cellulites recurrence and good primary and secondary patency rates at 1 year.

Microwave ablation of the liver in a live porcine model: the impact of power, time and total energy on ablation zone size and shape.

Objective: To explore various microwave (MW) time/power combinations to achieve maximum single-probe system performance in a live pig liver model.Methods: Fifty-one microwave ablations performed in 12 female pigs using the following time/power combinations: 65 W for 10 min (65W 10MIN), ramped from 20 to 65 W (RAMPED), 95 W pulses with cooling periods (95W PULSED), 40 W for 16 min 15 s (LOW POWER), 1 min 95 W pulse then 8 min 65 W then a second 1 min 95 W pulse (BOOKEND 95W) and 65 W for 15 min (65W 15MIN). Temperatures 1.5 cm from the antenna were measured. Livers were excised, and ablations were measured and compared.Results: At fixed overall energy, LOW POWER produced ablation zones with the smallest volume compared to 65W 10MIN, RAMPED and 95W PULSED. At a fixed time of 10-min, BOOKEND 95W protocol achieved wider and larger ablation zones than 65W 10MIN (p = 0.038, p = 0.008) and 95W PULSED (p = 0.049, p = 0.004). The 65W 15MIN combination had significantly larger diameters (p = 0.026), larger lengths (p = 0.014) and larger volumes (p = 0.005) versus 65W 10MIN. Maximum temperatures were highest with BOOKEND 95W (62.9 °C) and 65 W 15 MIN (63.0 °C) and lowest with LOW POWER (45.9 °C), p = 0.009.Conclusions: Low power ablations, even if controlled for total energy delivery, create small ablation zones. High peak powers are associated with larger ablation zones and high margin temperatures if cooling pauses are avoided. Ramping and pulsing protocols with interleaved cooling appear to be of no benefit versus continuous 65 W for creating large ablation zones.

Cone-beam computed tomography guided unipedicular central stentoplasty of the thoracolumbar spine: Early technical experience and results.

INTRODUCTION: An unipedicular vertebral body stenting technique, termed 'central stentoplasty', was developed at our institution. With this technique, a single vertebral body stent was deployed percutaneously in the midline of the vertebral body using cone-beam computed tomography (CBCT) guidance. METHODS: From September 2013 to July 2015, forty-four patients with fifty-six vertebral bodies underwent central stentoplasty. All fractures were of osteoporotic, traumatic or malignant aetiology. Information on vertebral body deformity, pre- and post-procedure sagittal index (SI), wedge angle (WA) and anterior vertebral height ratio was analysed. Two patients had combined ablation and stentoplasty for painful spinal metastases. RESULTS: There were 11 male and 33 female patients with mean age of 71.5 years (51-90 years). 19 fractured vertebral bodies had more than 30% loss of height. The mean pre-procedure SI was 0.82, and the mean post-procedure SI was 0.90. The pre-procedure WA was -5.56° compared with post-procedure mean WA of -3.47°. The mean pre-procedure segmental kyphosis was -4.58°, and the mean post-procedure segmental kyphosis was -1.46°. Six cases had minimal cement leak, and two cases had a haematoma at the puncture site. None of the patients underwent revision surgery, and postoperative neurological sequelae were not observed. CONCLUSION: 'Central stentoplasty' is a promising percutaneous vertebral fracture augmentation technique, which is shown to have low complication rates in the treatment of spinal compression fractures or metastases. However, long-term results need to be further evaluated.

Are cerebral ischaemic complications more likely to occur in elderly patients undergoing transradial non-coronary intervention: A single-centre retrospective review.

INTRODUCTION: Transradial artery access (TRA) is an established technique employed by interventional cardiologists for diagnostic and therapeutic coronary interventions. The use of TRA has gained increasing traction amongst interventional radiologists in recent years. In transradial, non-coronary interventions, the aorta has to be traversed. With increasing age, atherosclerotic changes in the aorta posed a theoretical risk of catheter-related emboli. Currently, there is limited literature available on the cerebral ischaemic complication rates in transradial non-coronary interventions. METHODS: Between November 2015 and December 2017, 150 transradial non-coronary interventions were performed on 95 patients. Intra-procedural, in-hospital, 30-day and 6-month complications (ischaemic stroke, transient ischaemic attack and death, and minor complications, such as puncture site haematoma, pseudoaneurysm, thrombosis, dissection and perforation) were compared between the two age groups (≤65 and >65 years old). RESULTS: The patients were predominantly male (87.0%) with age ≤65 (N = 69; 46.0%) and age >65 (N = 81; 54.0%). There were no ischaemic strokes at all time points in both groups, except for one case of ischaemic stroke at 6 months in the age ≤65 group(1.4% vs. 0.0%; P = 0.462). On multivariable analysis, age >65 was associated with lower in-hospital death rates (OR 0.251; 95% CI 0.013-3.09), at 30 days (OR 0.608; 95% CI 0.77-4.805) and at 6 months (OR 0.514; 95% CI 0.169-1.558) with no deaths intra-procedurally in both groups. Minor complications include puncture site grade I haematoma formation (2.9% vs. 2.5%; P = 0.999) and pseudoaneurysm (2.9% vs. 0.0%; P = 0.210). In our study, the overall major and minor complications rates are low and no statistically significant difference exists between the two groups. CONCLUSION: Transradial non-coronary interventions are safe in elderly patients, who are likely to have more atherosclerotic disease of the aorta. Of note, no complication of ischaemic strokes within 30 days of the procedure is documented in all patients.

Feasibility Study of "Snuffbox" Radial Access for Visceral Interventions.

"Snuffbox" radial access entails sheath insertion into the dorsal branch of the radial artery within the so-called anatomic snuffbox. The purpose of this report is to describe the technique and early experience in 50 visceral interventional procedures performed in 31 patients, which included liver embolotherapy, visceral arterial stent insertion, aneurysm embolization, and emergency embolization. In all cases, the procedures were successfully completed by using the snuffbox access, with a single case of asymptomatic pseudoaneurysm as the only access-related complication. Early experience showed that snuffbox radial access is technically feasible and represents a viable alternative to conventional radial access for visceral intervention procedures.

Complications and Reinterventions After Fenestrated and Branched EVAR in Patients with Paravisceral and Thoracoabdominal Aneurysms.

The application of endovascular strategies to treat aneurysms involving the abdominal and thoracoabdominal aorta has evolved significantly since the inception of endovascular aneurysm repair. Advances in endograft technology and operator experience have enabled the management of a wider spectrum of challenging aortic anatomy. Fenestrated endovascular and branched endovascular aneurysm repair represent two technical innovations, which have expanded endovascular treatment options to include patients with paravisceral and thoracoabdominal aortic aneurysms. Although similar in many ways to standard aortic endografts, fenestrated and branched endografts have specific short- and long-term complications due to their unique modular endograft design and their sophisticated deployment mechanisms. This article aims to examine the commonly encountered complications with these devices and the endovascular reintervention strategies.

Safety and Efficacy of Percutaneous Thermal Ablation of Juxta-Cardiac Hepatic Tumours.

INTRODUCTION: To evaluate the safety and efficacy of percutaneous thermal ablation of liver tumours in a juxta-cardiac (JC) location. MATERIALS AND METHODS: From January 2010 to December 2014, out of 274 cases of hepatic ablation, 33 consecutive patients who received thermal ablation (radiofrequency or microwave) to left hepatic lobe tumours were included in this study. Patients were divided into two groups: JC or non-juxta-cardiac (NJC) (tumour margin ≤ 10 mm or > 10 mm from the cardiac border, respectively). Imaging follow-up was performed at 6-week and 3-monthly intervals. Technical success, 30-day complications and local tumour control/recurrence were recorded. Statistical analysis was performed with t test and Fisher's test. Univariate and multivariate survival analyses were performed using Cox regression. RESULTS: Patients comprised of 23 men and 10 women (mean age 67.0 years). Mean tumour size was 2.2 ± 0.9 cm (28 hepatocellular carcinoma and 5 metastases). Mean follow-up time was 21.2 months (range 2-72 months). There were no differences between the JC and NJC groups in the rates of complete ablation (86.7 vs 83.3% P = 1.0), tumour recurrence (20.0 vs 22.2%, P = 0.95) or complication rates (6.7 vs 11.1% P = 1.0). Metastatic lesions were associated with a higher rate of recurrent disease (hazard ratio 3.86, 95% CI 1.0-14.8%, P = 0.05). DISCUSSION: Percutaneous thermal ablation of JC tumours has similar rates of local tumour control and safety profile when compared to tumours in a NJC location. Tumours in a JC location should not be considered a contraindication for thermal ablation.

Defining and predicting structurally conserved regions in protein superfamilies.

MOTIVATION: The structures of homologous proteins are generally better conserved than their sequences. This phenomenon is demonstrated by the prevalence of structurally conserved regions (SCRs) even in highly divergent protein families. Defining SCRs requires the comparison of two or more homologous structures and is affected by their availability and divergence, and our ability to deduce structurally equivalent positions among them. In the absence of multiple homologous structures, it is necessary to predict SCRs of a protein using information from only a set of homologous sequences and (if available) a single structure. Accurate SCR predictions can benefit homology modelling and sequence alignment. RESULTS: Using pairwise DaliLite alignments among a set of homologous structures, we devised a simple measure of structural conservation, termed structural conservation index (SCI). SCI was used to distinguish SCRs from non-SCRs. A database of SCRs was compiled from 386 SCOP superfamilies containing 6489 protein domains. Artificial neural networks were then trained to predict SCRs with various features deduced from a single structure and homologous sequences. Assessment of the predictions via a 5-fold cross-validation method revealed that predictions based on features derived from a single structure perform similarly to ones based on homologous sequences, while combining sequence and structural features was optimal in terms of accuracy (0.755) and Matthews correlation coefficient (0.476). These results suggest that even without information from multiple structures, it is still possible to effectively predict SCRs for a protein. Finally, inspection of the structures with the worst predictions pinpoints difficulties in SCR definitions. AVAILABILITY: The SCR database and the prediction server can be found at http://prodata.swmed.edu/SCR. CONTACT: 91huangi@gmail.com or grishin@chop.swmed.edu SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics Online.