Trimetazidine reduces contrast-induced nephropathy in patients with renal insufficiency undergoing coronary angiography and angioplasty: A systematic review and meta-analysis (PRISMA).

OBJECTIVES: This systematic review and meta-analysis assesses the utility of trimetazidine (TMZ) to prevent contrast induced nephropathy (CIN) in patients with renal insufficiency undergoing coronary angiography and angioplasty. MATERIALS AND METHODS: This meta-analysis was formulated and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of databases was conducted by 2 researchers independently for clinical trials, comparing hydration plus TMZ vs conventional hydration alone for prevention of CIN through January 2020. All patients had renal insufficiency (defined as GFR < 89 ml/minute/1.73 m2) and the outcome of interest was the incidence of contrast induced acute kidney injury. The odds ratio (OR) was estimated with 95% confidence interval (CI). Heterogeneity was reported with the I2 statistic, using a fixed-effects model, and >50% of I2 was considered to be statistically significant. RESULTS: Eleven studies, 1611 patients, met the inclusion/exclusion criteria: 797 patients comprised the TMZ plus hydration group and the remaining 814 patients comprised the control (hydration only) group. Heterogeneity was low I2 = 0%, P = .84, and the heterogeneity of each study was also low. The incidence of CIN in the TMZ plus hydration group was 6.6% (53/797), while the incidence of CIN in the control (hydration only) group was 20% (165/814). Pooled analysis of all studies showed TMZ reduced incidence of CIN compared to saline hydration alone (OR risk 0.30, 95% CI 0.21, 0.42, P < .0001). CONCLUSION: TMZ added to hydration reduces CIN in renal insufficiency patients undergoing coronary angiography.

Cystic adventitial disease-case series and review of literature.

Cystic adventitial disease (CAD) is a rare vascular disorder that involves the arteries and rarely the veins, most commonly found in the popliteal artery of male patients. Etiology of CAD is uncertain and currently without a consensus agreement. Clinically, the most common presenting symptom is claudication. Diagnosis requires a strong clinical suspicion in patients with intermittent claudication, but without other risk factors for atherosclerotic disease. Angiography, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) can all be used for diagnosis. Treatment of CAD can be done via surgical resection or percutaneous intervention such as aspiration. CAD can rarely recur after treatment.

Image-guided percutaneous ablation of lung malignancies: A minimally invasive alternative for nonsurgical patients or unresectable tumors.

Lung cancer remains the malignancy with the highest mortality and second highest incidence in both men and women within the United States. Image-guided ablative therapies are safe and effective for localized control of unresectable liver, renal, bone, and lung tumors. Local ablative therapies have been shown to slow disease progression and prolong disease-free survival in patients who are not surgical candidates, either due to local extent of disease or medical comorbidities. Commonly encountered complications of percutaneous ablation of lung tumors include pneumothorax, pleural inflammation, pleural effusions, and pneumonia, which are usually easily managed. This review will discuss the merits of image-guided ablation in the treatment of lung tumors and the underlying mechanism, procedural techniques, clinical utility, toxicity, imaging of tumor response, and future developments, with a focus on radiofrequency ablation.

Recurrent fracture of a recovery inferior vena cava filter with pulmonary migration.

Inferior vena cava (IVC) filters are indicated in patients with venous thromboembolic disease in whom standard anticoagulation therapy is contraindicated or ineffective. A 32-year-old female presented to our hospital with chest pain 5 years after IVC filter placement. Imaging revealed sequential fracturing and embolization of two of the IVC filter arms to the pulmonary arteries. IVC filter fracture and subsequent migration to the lung is a rare complication. Systematic long-term follow-up in patients with IVC filters and, if possible, filter removal should be considered to prevent possible complications.

Celiac artery stenting to facilitate hepatic yttrium-90 radioembolization therapy.

Radioembolization offers a novel way to treat the nonresectable, liver predominant hepatic malignancies with better tumor response and overall progression-free survival rates. Transarterial catheter-based radioembolization procedure involves the hepatic arterial administration of glass- or resin-based beta emitting Yttirum-90 microspheres. Safe delivery of the tumoricidal radiation dose requires careful angiogram planning and coil embolization to quantify lung shunting and prevent systemic toxicity, respectively. Diagnostic pretreatment angiogram also serves to identify the hepatic arterial variant anatomy and other coexisting pathologies that might require a different or alternative approach. We describe a complex case of celiac artery stenosis with tortuous pancreaticoduodenal arterial arcade precluding access to the right hepatic artery for performing radioembolization. Celiac artery stenting of the stenosis was performed to facilitate subsequent safe and successful Yttrium-90 microsphere radioembolization.