Inferior vena cava filter retrievals using advanced techniques: a systematic review.

This study aimed to assess the safety of complex inferior vena cava (IVC) filter retrieval techniques through a systematic review of published literature. Using PubMed, a systematic review was conducted in line with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to identify articles published through April 2020 that reported on complex IVC filter retrieval techniques in >5 patients. Case reports, review papers, and studies that did not report on primary outcomes or variables of interest were excluded. Risk of bias was assessed using a modified Newcastle-Ottawa Quality Assessment scale. Pooled success and complication rates were calculated for the overall number of complex retrieval attempts as well as for each filter type and each complex retrieval method. Sixteen fair-quality and three good-quality studies met the inclusion criteria, with 758 patients (428 female) who had undergone 770 advanced retrieval attempts. The mean age of the patients was 46.5 ± 7.1 years (range: 14.1-90), and the mean dwell time was 602.5 ± 388.6 days (range: 5-7336). Regarding filters, 92.6% (702/758) were retrievable and 7.4% (56/758) were permanent. Indications for complex retrieval included the failure of standard retrieval (89.2%; 676/758) and tilting or embedding in the caval wall (53.8%; 408/758); 92.6% (713/770) of the advanced retrieval attempts were successful. The pooled success rate was 92.0% (602/654) for retrievable filters and 96.4% (53/55) for permanent filters (P = 0.422). Only 2.8% (21/758) of patients experienced major complications, and the major complication rate was not significantly associated with filter type (P = 0.183). Advanced techniques for IVC filter retrieval appear safe for the retrieval of retrievable filters and certain permanent filters, with a low short-term major complication rate. Further studies on complex retrieval techniques used to remove permanent filters should be conducted to clarify their safety with respect to filter type.

Perioperative Blood Loss after Preoperative Prostatic Artery Embolization in Patients Undergoing Simple Prostatectomy: A Propensity Score‒Matched Study.

PURPOSE: To assess perioperative blood loss following prostatic artery embolization (PAE) before surgery in patients undergoing simple prostatectomy. METHODS: A retrospective chart review was used to identify 63 patients (mean age, 65.3 ± 8.0 years) with prostatic hypertrophy and severe lower urinary tract symptoms who underwent prostatectomy from September 2014 to December 2019, 18 (28.5%) of whom underwent PAE before surgery. Demographic data, pertinent laboratory results, procedural or operative information, hospital course details, and pathology reports were obtained. A 2:1 propensity score‒matching analysis was performed to compare intraoperative blood loss in patients who underwent prostatectomy alone with intraoperative blood loss in those who first underwent bilateral PAE before surgery. RESULTS: Sixteen (89%) of the 18 patients underwent bilateral PAE before surgery. Thirty-two patients who underwent prostatectomy without embolization before surgery were selected for the 2:1 propensity score‒matched analysis based on age, race, surgery type, prostate gland size, and comorbidities. The mean estimated blood loss (EBL) for prostatectomy alone was 545 ± 380 mL (mean ± standard deviation). There was a statistically significant reduction in the EBL for patients who underwent bilateral PAE (303 ± 227 mL, P < .01). The operative time was also significantly decreased for patients who underwent PAE before surgery (P < .05). For patients who underwent PAE, there were no complications related to the procedure. CONCLUSIONS: Bilateral PAE before surgery appears to be safe and may be effective in reducing perioperative bleeding and operative time.

Preoperative embolization of renal cell carcinoma prior to partial nephrectomy: A systematic review and meta-analysis.

PURPOSE: To evaluate the safety and efficacy of preoperative renal artery embolization of renal cell carcinoma in reducing intraoperative blood loss during subsequent partial nephrectomy through a systematic review and meta-analysis of current literature. MATERIALS AND METHODS: The PubMed database was searched for articles published from 1970 to 2018 describing patients with renal cell carcinoma who underwent partial nephrectomy with and without preoperative embolization of the tumor. Demographic data, procedural techniques, and surgical outcomes were obtained when available. A random-effects meta-analysis was performed to determine estimated blood loss in both groups of patients. RESULTS: The literature search identified 14 relevant articles for systematic review, of which 4 articles provided sufficient data to be included in the meta-analysis. 270 patients (173 males, 97 females) underwent partial nephrectomy for RCC, of whom 222 received pre-operative embolization. There were 48 patients in our cohort that underwent partial nephrectomy for RCC without preoperative embolization. Random-effects meta-analysis demonstrated a significant difference between EBL in patients undergoing RAE prior to partial nephrectomy vs partial nephrectomy without preoperative embolization, with EBL of 154.0 ± 22.6 mL (n = 222) and 353.4 ± 69.6 mL (n = 478), respectively (p < 0.0001). Major complications occurred in 4.9% of patients undergoing pre-operative embolization followed by partial nephrectomy, whereas major complications occurred in 10.9% of patients undergoing partial nephrectomy without embolization (p = 0.01). Minor complications occurred in 5.8% of patients undergoing embolization and partial nephrectomy and in 19.0% of patients undergoing partial nephrectomy without embolization (p < 0.0001). CONCLUSION: Renal artery embolization prior to surgical resection of renal cell carcinoma is safe and significantly reduces intraoperative blood loss in patients undergoing partial nephrectomy.

Perioperative blood loss after embolization of hypervascular musculoskeletal tumors outside of the spine: A single-center ten year experience and systematic review of the literature.

PURPOSE: To evaluate outcomes following trans-arterial embolization of hypervascular appendicular bony tumors in patients undergoing orthopedic resection by performing a systematic review including data from the authors' institution. MATERIALS AND METHODS: From April 2008 to August 2018, 73 patients (59 males, mean age 58.1 years) with musculoskeletal tumors presented for embolization for preoperative devascularization prior to orthopedic surgery. A retrospective chart review was performed to identify demographic, procedural and surgical data. A systematic review of the Pubmed, Medline, and Web of Science databases was performed to identify studies in which pre-operative embolization was performed of appendicular MSK tumors, and with measurements of estimated blood loss. All the variables listed above were recorded. A patient level analysis was performed to determine average estimated blood loss. RESULTS: 58 patients (47 men, 11 women, range 21-84 years) were included in our institutional analysis. The median EBL was 500 mL (range 100-3000). There was no difference in EBL between RCC (719.6 ± 626.1) and non-RCC groups (855.6 ± 657.5); p = 0.44. The median intra-operative transfusion requirement was 1.0 unit (range 0-8 ± 2.06). From 1984 to 2015, 9 studies were identified that provided data for a total of 118 patients (46 males, 42 females, range 10-82 years). The mean and median post-surgical EBL across all patients was 976.9 ± 78.5 (SE) and 725 mL (range 10-7000), respectively. There were no complications related to non-target embolization. CONCLUSION: Preoperative trans-arterial embolization of hypervascular MSK neoplasms appears to be safe and effective in minimizing peri- and post-operative bleeding while keeping transfusion requirements low.

Percutaneous Ablative Therapies for the Management of Osteoid Osteomas: A Systematic Review and Meta-Analysis.

PURPOSE: To evaluate safety and efficacy of percutaneous ablative therapy for the treatment for osteoid osteomas. MATERIALS AND METHODS: PubMed database, Web of Science, and SCOPUS were searched from their inception until November 2019 for articles describing osteoid osteoma. Demographic data, success rates, pre- and post-procedure VAS scores, and complications were recorded. A random-effects meta-analyses of the VAS pain score at various time points were calculated. RESULTS: For radiofrequency ablation, VAS scores for pain at pre-procedure, 24-48 h, and 3-6 months yielded cumulative pain scores of 7.64 +/- 0.175, 0.78 +/- 0.186, and 0.02 +/- 0.0196, respectively. For cryoablation, VAS scores at pre-procedure, 24-48 h, and 3-6 months yielded cumulative pain scores of 8.46 +/- 0.549, 0.975 +/- 0.66, and 0.112 +/- 0.08, respectively. For laser ablation, VAS scores at pre-procedure and 24-48 h yielded cumulative pain scores of 4.94 +/- 1.42, and 0.506 +/- 0.268, respectively. For microwave ablation, VAS scores at pre-procedure, 24-48 h, and 3-6 months yielded cumulative pain scores of 6.14 +/- 1.07, 1.636 +/- 1.215, and 0 +/- 0.0, respectively. All ablation methods resulted in significant immediate and lasting pain reduction (p < 0.001). Technical and clinical success rates and major complications for RFA, microwave ablation, laser ablation, and cryoablation did not differ significantly. Overall recurrence of bone pain at the same site occurred in 4.06% of all patients an average of 11 months post-procedure. CONCLUSION: Percutaneous ablative therapies are safe and result in significant and lasting pain reduction as demonstrated through visual analog scale pain scores.

Safety and Efficacy of Endovascular Treatment of Portal Vein Stenosis in Liver Transplant Recipients: A Systematic Review.

PURPOSE: To evaluate the efficacy of Angioplasty and Stent Placement for the treatment of Portal Vein Stenosis in Liver Transplant Recipients by performing a systematic review. MATERIALS AND METHODS: The PubMed Database was extensively searched for articles describing Portal Vein Stenosis (PVS) as a complication in Liver Transplant (LT) patients. The initial database search yielded 488 unique records published in the PubMed Database, 19 of which were deemed to meet the inclusion criteria. Outcomes were separated into 2 groups (Group A included patients with primary angioplasty, Group B included patients with primary stent placement), and further subdivided into Adult and Pediatric populations. RESULTS: Group A included a total of 282 LT patients with portal vein stenosis. The population was predominantly pediatric (n = 243). Group B included a total of 111 LT patients with portal vein stenosis. This population was predominantly adult (n = 66). Technical success was significantly higher in both Group B pediatric (100%) and adults (97%) compared to Group A (69.5%) and (66.7%) respectively. Re-stenosis rates were significantly lower in Group B pediatric group compared to Group A (2.3% vs 29.7%, χ2 = 13.9; p < 0.001). Overall major (3.1%) and minor complications rates (1.5%) were low. CONCLUSION: Primary stent placement appears to have higher technical success in both populations and lower re-stenosis rates for treatment of PVS in pediatric populations.

Safety and Feasibility of Transradial Access in Patients Presenting With Traumatic Injuries: A Single Urban Center Experience.

PURPOSE: To evaluate the efficacy, safety, and feasibility of transradial approach (TRA) for endovascular management of traumatic bleeding. MATERIALS AND METHODS: A retrospective review was performed at a single level 1 trauma institution from August 2018 to July 2019. Patients presented to the interventional radiology department who were intended to be treating using TRA for the management of trauma-induced bleeding were selected. Demographics, indication for embolization, embolization site, preprocedural labs, hemodynamic stability, technical success, and complications were recorded. RESULTS: Transradial approach was attempted in 29 (74.4%) of the 39 patients identified by operators who prefer TRA. Four patients received treatment using TRA on 2 separate occasions, for a total of 33 procedures completed with a technical success of 97% (32/33). Transradial approach was safely completed in 9 patients (27.3%) with preprocedural hemodynamically unstable status. For the 10 patients who received treatment via a transfemoral approach (TFA), traumatic disfiguration of the left upper extremity, preexisting arterial lines placed by the trauma team, and external iliac artery injuries requiring covered stent placement were the most common indications for TFA over TRA. There were no procedural or access site-related complications. CONCLUSION: Transradial approach for the endovascular management of bleeding in a trauma setting is safe and effective with a high technical success rate and no complications.

Trauma CT evaluation prior to selective angiography in patients with traumatic injuries: negative predictive power and factors affecting its utility.

PURPOSE: To evaluate the predictive power of arterial injury detected on contrast-enhanced CT (trauma CT (tCT)) imaging obtained prior to selective angiography for treatment of patients with traumatic abdominal and pelvic injuries. MATERIALS AND METHODS: A retrospective chart review was performed of all patients who underwent angiography after undergoing contrast-enhanced CT imaging for the evaluation/treatment of traumatic injuries to the abdomen and pelvis between March 2014 and September 2018. Data collection included demographics, pertinent history and physical findings, CT and angiography findings, treatment information, and outcomes. RESULTS: Eighty-nine (63 males, mean age = 45.8 ± 20.5 years) patients that were found to have 102 traumatic injuries on tCT and subsequently underwent angiography met inclusion criteria for this study. Sixty-four injuries demonstrated evidence of traumatic vascular injury on initial tCT. A negative tCT was able to predict subsequent negative angiography in 83% of cases (negative predictive power = 83%). The ability of tCT to rule out a positive finding on subsequent angiography was also 83% (sensitivity = 83%). The average systolic blood pressure and hemoglobin concentration at the time of tCT were higher in patients who had positive tCT than in patients with negative tCT (p < 0.05 and p < 0.01, respectively). The average time to angiography was greater in patients whom had subsequent negative angiography than the patients who had subsequent positive angiography (p < 0.05). CONCLUSION: Contrast-enhanced CT imaging may be able to help stratify patients who may have subsequent negative angiograms. Hemodynamic factors may affect sensitivity of tCT. Shorter time to angiography may increase the chance of identifying the injury on subsequent angiography.

Readability Assessment of Internet-based Patient Education Materials Related to Treatment Options for Benign Prostatic Hyperplasia.

RATIONALE AND OBJECTIVES: To assess the current readability levels for online Internet-Based Patient Education Materials (IPEMs) related to treatment options for benign prostatic hyperplasia, including transurethral resection of prostate (TURP) and prostate artery embolization (PAE). MATERIALS AND METHODS: Using the Google search engine we identified 40 IPEMs pertaining to TURP and PAE. Readability analysis was performed using the following algorithms: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Formula (FKGL), Simple Measure of Gobbledygook (SMOG), and the Gunning Frequency of Gobbledygook (GFOG). Scores are categorized by difficulty (FRES) and grade level (FKGL, SMOG, GFOG). RESULTS: Only 7.5% (3/40) websites met the United States Department of Health and Human Services recommendation of a sixth grade or lower comprehension levels, with FRES scores in the "fairly easy" category. Comparison of TURP to PAE groups showed that TURP readability scores with respect FRES and FKGL were significantly easier to read. According to SMOG and GFOG analysis there was no difference between the two groups by grade level, which demonstrated an average at the 12th grade reading level. Subgroup analysis of IPEM type, categorized as Health Networks (12), University Hospitals (14), Clinical Practices (6), and Miscellaneous (8), found no difference in reading level across all scoring systems. CONCLUSION: Currently available IPEMs pertaining to benign prostatic hyperplasia treatment options are written at a level that is too difficult for the average American to understand. Physicians and health networks should take United States Department of Health and Human Services recommendations into consideration when designing IPEMs to optimize accessibility of health information to improve patient compliance and outcomes.

Endovascular Management of Hemarthrosis in Patients with Bleeding Diatheses: Systematic Review.

PURPOSE: In this systematic review, we report the safety and efficacy of embolization for treating hemarthrosis in patients with bleeding diatheses with or without a history of prior arthroplasty. MATERIALS AND METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, MEDLINE, and SCOPUS databases of patients undergoing embolization for hemarthrosis. Demographic data, clinical history, angiographic findings, interventions, and outcomes were extracted and tabulated. RESULTS: The search identified 97 unique titles of which 15 were deemed relevant comprising 78 patients with coagulopathies undergoing 93 embolization procedures. Mean follow-up time was 29 months (range 3-116.5). In the 29 patients who underwent arthroplasty prior to embolization for hemarthrosis, there were 11 bleeding recurrences (37.9%). Of these patients who experienced recurrences, 10 underwent repeat embolization as coagulation factor replacement was not sufficient to address the re-bleeding. In the 49 patients with bleeding diatheses who underwent embolization for hemarthrosis with no history of prior arthroplasty, there were 11 recurrences (22.4%) and 4 of these patients underwent repeat embolization with favorable results. There were four major procedure-related complications. CONCLUSION: Transarterial embolization is safe and effective in addressing recurrent hemarthrosis in patients with bleeding diatheses with or without a history of arthroplasty of the affected joint.