Endovascular Treatment of Peripheral Arteriovenous Malformations (AVMs): Do Angiographic Outcomes Relate to the Quality of Life?

PURPOSE: Patients with arteriovenous malformations (AVMs) have a lower health-related quality of life (QoL) than the general population. QoL assessment of patients with peripheral AVMs after endovascular treatment is scarce in the literature. Radiologic and clinical outcomes are not always correlated in vascular malformation treatment. This study aimed to investigate the relationship between clinical outcomes, QoL, and angiographic outcomes. MATERIALS AND METHODS: Patients with peripheral AVM that underwent endovascular treatment between January 2009 and December 2021 in a single center were retrospectively evaluated. Patients' characteristics (age, sex), AVM characteristics (Schobinger classification, location, angiographic architecture), previous treatment, treatment characteristics (type of endovascular approach, embolizing agent and number of sessions), percentages of angiographic response, complications, and recurrence were evaluated. The angiographic architecture was evaluated according to the Yakes classification. The questionnaire was applied for evaluation of clinical response and QoL. Patients older than 12 years and those who can be contacted were included in clinical and QoL analysis. Clinical response was defined as improvement in the patient's most important pretreatment symptom. Treatment response was defined as clinical response plus >50% angiographic response. RESULTS: Eighty-six patients (41 males [47.7%], 45 females [52.3%]) were included in angiographic analysis. The mean age was 28.44±12.99 years (range=5-61). Forty-three patients (50%) had previous treatment. The median number of sessions was 2 (range 1-15, InterQuartile Range [IOR]=2). Sixty-one patients (30 males [49.2%], 31 females [50.8%]) were included in clinical analysis. The clinical response rate was 73.8%, 95% confidence interval (CI) [0.60, 0.84]. The treatment response rate was 45.9%, 95% CI [0.33, 0.59]. The complication rate was 8.2%. Before treatment, 48 patients (78.7%) reported a negative impact on their QoL. Thirty-three of 48 patients (68.8%) reported improvement on their QoL after treatment. Higher Schobinger stages were related to a negative impact on QoL before treatment (p<0.01). Yakes types were not related to QoL (p=0.065). Clinical response was related to improvement on QoL after treatment (p<0.01). Angiographic and treatment responses were not related to improved QoL after treatment (p=0.52 and p=0.055, respectively). CONCLUSION: Angiographic architecture and outcomes were not always reflected in QoL after endovascular treatment. CLINICAL IMPACT: This study's findings will help clinicians with what to focus on in AVM treatment and how to monitor patients with peripheral AVM after endovascular treatment. Rather than relying too much on the angiographic response, patients should be checked for symptoms and quality of life improvement. No clear data in the literature regarding the applicability of the Yakes Classification in patients with previous treatment. This study questioned the applicability of the Yakes Classification in patients with previous treatments. In this study, type 4 AVMs were more common in patients with previous treatment.

Trapezius Port Placement in Patients with Breast Cancer: Long-Term Follow-up and Quality-of-Life Assessment.

PURPOSE: To evaluate the long-term results of and patient satisfaction with trapezius ports in breast cancer patients, as an alternative to chest ports. PATIENTS AND METHODS: This retrospective study included all patients who underwent trapezius port placement from December 2007 to January 2017. Seventy female patients with breast cancer, with a mean age of 54 ± 9.9 years (range, 29-76 years), were included. Indications for trapezius implantation were bilateral breast surgery or unilateral breast surgery and contralateral breast involvement. Sixty-eight of 70 patients had long-term follow-up. A retrospective, questionnaire-based survey was conducted to assess satisfaction and the trapezius port's effect on the daily life of the patient. RESULTS: All implantations were technically successful. Total catheter service time for 68 patients was 65,952 days (2 patients were lost to follow-up). Mean catheter service time was 969.8 days (range 7-3,458 days; median 570 days; 95% confidence interval, 739-1199; standard deviation, 947.7). No immediate procedural complications occurred. Port complications developed in 4 patients (5.9%); port infection developed in 2 patients (0.03/1,000 days); skin dehiscence developed in 1 patient (0.02/1,000 days); and port malfunction developed in 1 patient (0.02/1,000 days). The overall infection rate was 2.9% (2/68). All patients (n = 44) or a close relative (n = 17) who were interviewed with a phone call reported satisfaction regarding their ports. CONCLUSIONS: Trapezius ports offer a safe and feasible option to patients with breast cancer who need an alternative site to chest ports. It is also associated with high overall patient satisfaction.

Clinical and Molecular Study of ELMO-2-Related Massive Intraosseous Vascular Malformations: Lessons Learned From 25 Years of Follow-up.

Massive intraosseous vascular malformations, a relatively rare entity in the vascular malformation spectrum, deserves attention as involving the membranous bones of the craniofacial skeleton and may lead to severe life-threatening hemorrhages and even death. The main aim of this study was to summarize the 25 years of clinical experience with these vascular malformation osseous patients, focus on the molecular and genetic aspect of the clinical entity, and to emphasize the certain challenging conditions in the treatment of these patients. All the patients appeared to be unaffected at birth, whereas initial symptoms occasionally began with painless swelling in the mandible in early childhood. The disease was progressive in behavior especially in the pubertal ages and was specifically involving the maxilla and mandible of the craniofacial skeleton in all the patients. Calvarium and cranial base were the second most common involved regions among these patients (62.5%). Clavicular (50%), costal (25%), and vertebral (25%) involvements were also a significant manifestation of the disease. Tissue samples obtained from the affected individuals and the blood samples from their families were matched, revealing a loss of function mutation in the ELMO-2 gene of chromosome 20 leading to developmental abnormality of the vascular structures via RAC1 signaling and leading to abnormally enlarged vessels in the intraosseus portion of the membranous bone. Immunohistochemical staining revealed positive CD31 and smooth muscle actin staining but negative proliferation and maturity markers such as Ki-67, desmin, h-caldesmon, and myofibroblast-like desmin. The follow-up of 3 of 5 patients ended up with mortality (60%). vascular malformation osseous is intraosseous vascular malformation with aggressive biological behavior associated with ELMO-2 gene mutation. Further studies for obtaining prenatal diagnosis and achievement of gene therapy should take place. As the disease rapidly progresses as the affected individual grows, surgical interventions should be taken into consideration before the initiation of complications.

A Post-International Gastrointestinal Cancers' Conference (IGICC) Position Statements.

Hepatocellular carcinoma (HCC), the most prevalent liver tumor, is usually linked with chronic liver diseases, particularly cirrhosis. As per the 2020 statistics, this cancer ranks 6th in the list of most common cancers worldwide and is the third primary source of cancer-related deaths. Asia holds the record for the highest occurrence of HCC. HCC is found three times more frequently in men than in women. The primary risk factors for HCC include chronic viral infections, excessive alcohol intake, steatotic liver disease conditions, as well as genetic and family predispositions. Roughly 40-50% of patients are identified in the late stages of the disease. Recently, there have been significant advancements in the treatment methods for advanced HCC. The selection of treatment for HCC hinges on the stage of the disease and the patient's medical status. Factors such as pre-existing liver conditions, etiology, portal hypertension, and portal vein thrombosis need critical evaluation, monitoring, and appropriate treatment. Depending on the patient and the characteristics of the disease, liver resection, ablation, or transplantation may be deemed potentially curative. For inoperable lesions, arterially directed therapy might be an option, or systemic treatment might be deemed more suitable. In specific cases, the recommendation might extend to external beam radiation therapy. For all individuals, a comprehensive, multidisciplinary approach should be adopted when considering HCC treatment options. The main treatment strategies for advanced HCC patients are typically combination treatments such as immunotherapy and anti-VEGFR inhibitor, or a combination of immunotherapy and immunotherapy where appropriate, as a first-line treatment. Furthermore, some TKIs and immune checkpoint inhibitors may be used as single agents in cases where patients are not fit for the combination therapies. As second-line treatments, some treatment agents have been reported and can be considered.

Fluorescence-guided extended pelvic lymphadenectomy during robotic radical prostatectomy.

We evaluated and described the impact of prostatic indocyanine green (ICG) injection on extended pelvic lymph node (LN) dissection (ePLND) in robotic-assisted radical prostatectomy (RARP). Between January 2019 and December 2021, we included consecutive 50 PCa patients who underwent ePLND during RARP with (n = 25) or without (n = 25) prostatic ICG injection. ICG injection was performed during abdominal port placement and robot docking. Pelvic LNs reflecting green color were initially excised and then the template was completed. The outcomes of two groups were compared. Overall, nine (36%) and five (20%) of the patients had metastatic LN involvement in the ICG and non-ICG groups, respectively. Of the 509 dissected LNs in the ICG group, 122 (23.9%) were fluorescence active. 20 LNs (3.9%) were metastatic in this group, 9 (45%) of which were ICG+. 408 LNs were resected on the non-ICG group with 8(1.9%) being metastatic. Eight (88.9%) of nine pN+ patients were florescent positive in the ICG group. Out of six patients with pN+ disease, Ga68 PSMA-PET/CT detected positive LNs preoperatively. In addition to preoperative Ga68 PSMA-PET/CT investigation, ICG-guided ePLND might increase identification and removal of metastatic LNs duirng RARP. Improvements in staging and oncologic outcomes may also be seen in intermediate- and high-risk patients.

Endovascular management of renal angiomyolipomas: Do coils have a benefit in terms of clinical success rates?

PURPOSE This study evaluated single center results of endovascular treatment in renal angiomyolipoma (AML) to determine whether there is clinical relevance of adding proximal coil embolization to distal particle embolization in terms of safety, efficacy and retreatment rates. METHODS A retrospective analysis was performed to evaluate patients undergoing transarterial embolization for renal AMLs from January 2007 to October 2020. Parameters regarding patient and tumor characteristics, embolization technique, treatment outcome and complications were recorded. Patients were divided into two groups as A (only particle group) and B (particle + coil group) based on the type of embolic agent used for treatment. Comparative analysis was performed between the two groups in terms of tumor size reduction, retreatment and complication rates. RESULT Forty-two patients (37 (88.1%) female, 5 (11.9%) male) harboring 48 AMLs were included in the study. The mean age was 43.46 (range 20 to 78). The technical success rate was 95.8% (46 of 48 procedures). The mean size reduction was 1.94±1 cm (p < 0.001) after treatments however, no significant difference was seen between groups in terms of tumor size reduction. Retreatment rates were 3.1% (1 of 32 cases) in group A and 14.3% (2 of 14 cases) in group B (p = 0.21). No significant difference was found between groups in terms of bleeding and complication rates during the perioperative period. Mean follow-up duration was 26.48±25.71 (range from 2 to 102) months. CONCLUSION In this study, no clear supplementary benefit was observed in terms of safety, and efficacy with the adjunction of coils to distal particle embolization in the management of AMLs.

An intrathyroidal nodule consisting of papillary thyroid cancer and ectopic hyperechoic parathyroid adenoma: a case report.

A 53-year-old woman with fatigue lasting for 6 weeks and increased parathormone level underwent a neck ultrasound. It revealed a large, lobulated, solid intrathyroidal nodule consisting of hypoechoic component with microcalcifications and hy-perechoic component with vascularity on Doppler mode. There were also subcentimetric intrathyroidal hypo- and hyperechoic nodules. Upon the diagnosis of papillary thyroid cancer on fine-needle aspiration biopsy, a total thyroidectomy procedure was performed. In the histopathologic evaluation, the hypoechoic component was diagnosed as papillary thyroid cancer, while the hyperechoic component was diagnosed as ectopic parathyroid adenoma. Subcentimetric nodules were demonstrated as multi-foci of papillary thyroid cancer.

Pathological Accuracy in Prostate Cancer: Single-Center Outcomes of 3 Different Magnetic Resonance Imaging-Targeted Biopsy Techniques and Random Systematic Biopsy.

OBJECTIVE: The aim of this study is to compare systematic, cognitive fusion, in-bore, and software fusion prostate biopsies regarding rates of and risk factors for pathological upgrading. MATERIAL AND METHODS: Charts of 291 patients with systematic biopsy (n = 105), magnetic resonance imaging- targeted cognitive fusion (n = 58), in-bore (n = 68), and software fusion biopsy (n = 60), and who subsequently underwent radical prostatectomy were retrospectively evaluated. The degree of similarity between the grade groups reported in the biopsy and radical prostatectomy pathology results was recorded. Analyses of the associated factors for concordance and discordance were performed with univariate and multivariate methods. RESULTS: The concordance rates were as follows: systematic biopsy = 42.8%, cognitive fusion-targeted biopsy = 50%, in-bore fusion-targeted biopsy = 61.8, and software fusion biopsy = 58.4%. The upgrade rate of systematic biopsy (46.6%) was higher than cognitive fusion-targeted biopsy (27.6%), in-bore fusiontargeted biopsy (26.4%), and software fusion-targeted biopsy (18.3%). The number of positive cores was significantly associated with grade group concordance for the systematic biopsy group (P = .040). Within the cognitive fusion-targeted biopsy cohort, number of positive cores was the only parameter that exhibited a significant association with grade group concordance in multivariate analysis (P = .044). Considering the in-bore fusion-targeted biopsy group, maximum tumor length was statistically significant (P = .021). In the software fusion-targeted biopsy group, low prostate volume was found to be the only significant predictor for grade group accordance (P = .021). CONCLUSION: Magnetic resonance imaging-targeted biopsy techniques showed higher concordance and lower upgrade rates compared to systematic biopsy. For systematic biopsy and cognitive fusion-targeted biopsy, the number of positive cores was associated with grade group concordance, while maximum tumor length in in-bore fusion-targeted biopsy and low prostate volume for in-bore fusion-targeted biopsy were associated with grade group concordance. Among the MRI-targeted biopsy methods, in-bore fusion-targeted biopsy and software fusion-targeted biopsy were more accurate than cognitive fusion-targeted biopsy in terms of grade group.

Non-occlusive hepatic artery hypoperfusion syndrome and imaging findings: a systematic review.

Non-occlusive hepatic artery hypoperfusion syndrome (NHAHS), in other words, splenic steal, is a rare disorder that can arise following liver transplantation. After liver transplantation, its frequency has been defined as between 0.6 and 10.1%. The diversion of flow from hepatic to splenic arteries results in low perfused hepatic artery which causes elevated liver enzymes, hyperbilirubinemia, and graft dysfunction. This may result from a high resistance in the hepatic arteries, enlarged splenic arteries, a limited hepatic arterial flow due to high portal flow, or a discordance of the graft size and hepatic arterial flow. There may be a need for some prophylactic and/or posttransplant treatment procedures. We aimed to describe pre and post-treatment imaging findings of NHAHS.

The role of selective venous sampling in patients with non-localized primary hyperparathyroidism.

OBJECTIVES: The aim of this observational clinical study was to evaluate the success of angiographic selective venous sampling (ASVS) in locating parathyroid adenoma in patients with primary hyperparathyroidism (PHPT), in whom the other imaging modalities have failed, and and to evaluate its possible contribution to the applicability of minimal invasive surgery. MATERIAL AND METHODS: Fifty-five patients who were admitted to our hospital's General Surgery department between January 2012 and January 2015 for PHPT in whom ultrasound and sestamibi scintigraphy have failed to localize the diseased gland were included to the study. Patients were divided into two groups: those who underwent ASVS and those who did not. The outcomes of patients were reviewed retrospectively. RESULTS: Among 55 patients, 20 underwent ASVS. ASVS successfully lateralized the diseased gland in 17 (85%) patients, and minimally invasive parathyroidectomy could be performed in 14 (70%) patients. The cut-off value of parathormon gradient was considered 10% for lateralization and the accuracy of ASVS in lateralization was 94.1%. In 11 (59%) patients, the superior-inferior discrimination could be achieved in addition to lateralization. CONCLUSION: ASVS has a high sensitivity in locating the diseased gland in patients with PHPT in whom ultrasound and sestamibi scan have failed, and thereby, rendering the performance of minimally invasive surgery possible. Further studies may reveal the role of ASVS in providing useful information about not only lateralization but also the superior-inferior discrimination.

Outcomes of Radioembolization in Patients with Chemorefractory Colorectal Cancer Liver Metastasis: a Single-Center Experience.

PURPOSE: We aimed to evaluate the efficacy and outcomes of radioembolization with Yttrium-90 (Y-90) microspheres in patients with unresectable and chemorefractory colorectal cancer liver metastasis (CRCLM). METHODS: This single-center study included 43 patients (34 male, 9 female) who underwent radioembolization with Y-90 for unresectable, chemorefractory CRCLM between September 2008 and July 2014. Overall survival (OS), liver progression-free survival (LPFS), overall response rate (ORR), local disease control rate (LDCR), and relations of these parameters with patient disease characteristics were evaluated. OS and LPFS rates were compared according to microspheres. Survival rates were calculated with Kaplan-Meier method, and potential prognostic variables were evaluated on univariate analyses. RESULTS: Post-procedural median OS was 12.8 months. LPFS was 5.6 months. ORR was 33%, LDCR was 67% on 3rd month follow-up. Low tumor burden (< 25%) was associated with higher median OS after radioembolization (< 25 vs > 25-50% p < 0.0001 and < 25 vs > 50% p = 0.005). Patients with left colon tumors exhibited significantly longer median OS after metastasis than right colon tumors (p = 0.046). Extrahepatic disease and synchronicity showed poorer survival parameters; however, the difference was not significant (p = 0.1 and p = 0.3, respectively). In subgroup analyses, the distribution of patient number and characteristics showed heterogeneity as number of patients with low tumor burden was higher in resin Y-90 group. Resin Y-90 group exhibited significantly higher median OS and LPFS compared to glass Y-90 group (16.5 vs. 7 months, p = 0.001; 6.73 vs. 3.38 months, p = 0.023, respectively). CONCLUSION: Radioembolization is a safe local-regional treatment option in chemorefractory, inoperable CRCLM. Radioembolization at earlier stages may lead to more favorable results especially with lower tumor burden patients.

Life-threatening gastrointestinal system bleeding in Hodgkin disease: multidetector CT findings and review of the literature.

Acute lower gastrointestinal system (GIS) bleeding is a life-threatening condition. Immediate determination of the origin of the bleeding is crucial, since hemostatic management must be initiated as rapidly as possible. Colonoscopy, radionuclide studies, and conventional angiography are considered the most important methods for assessing the origin of the bleeding. There are few published reports about the feasibility of computed tomography (CT) in acute GIS bleeding. We present multidetector CT (MDCT) findings in a case of Hodgkin disease status one month post-chemotherapy (CHOP protocol; cyclophosphamide, doxorubicin, vincristine, prednisone) that presented with acute lower GIS bleeding.

Subcutaneous venous port implantation in adult patients: a single center experience.

PURPOSE: To present the midterm follow-up results of subcutaneous venous chest ports in adult patients. MATERIALS AND METHODS: Between January 2001 and November 2005, 476 subcutaneous venous chest ports were placed in 472 adult patients. Five patients underwent port implantation twice. All the ports had single lumen catheters. The procedures were performed under intravenous sedation as well as local anesthesia. All ports were placed on the anterior chest wall, except one, which was placed on the trapezius muscle. RESULTS: The technical success rate was 99.8%. The procedure- related minor complication rate was 0.63% (total: 3 cases; 1 hematoma during local anesthesia application, and 2 early hematomas) and there were no major complications. Mean duration of catheter usage was 376 days (total: 178,997 catheter days; range: 2 to 1522 catheter days). Late complications occurred at a rate of 10.7% (51 cases). Among those 51 cases, 36 (7.6%) developed minor complications in which port removal was not needed; however, 15 ports (3.15%) had to be removed due to major complications. Seven ports (1.47%) were explanted due to treatment-resistant bacteremia and sepsis, in addition to 2 other ports (0.42%) because of port pocket infections. An additional 6 ports (1.26%) required explantation for the following reasons: skin necrosis (0.21%); incision dehiscence (0.21%); broken or torn catheter (0.42%); jugular vein thrombosis (0.21%); thrombosis of superior caval vein (0.21%). CONCLUSION: Radiological implantation of subcutaneous venous ports can be performed with similar or lower complication rates as compared to the surgical literature, due to the obvious advantage of imaging guidance. Hence, we think that port implantation with imaging guidance will become the preferred implantation method in the future.

Endovascular treatment of peripheral and visceral arterial injuries in patients with acute trauma.

BACKGROUND: The present study is an evaluation of the efficacy of endovascular treatment in emergency setting for patients with acute peripheral and visceral arterial injury secondary to penetrating or blunt trauma. METHODS: Twelve patients (11 men) aged 35.8±11.3 years (range: 18-56 years) with penetrating or blunt trauma who underwent endovascular treatment in our department between March 2010 and June 2014 for peripheral and visceral arterial injury were retrospectively reviewed. Selective coil embolization was performed on 11 patients and particle embolization of the injured vessel was performed on 1 patient. Criteria for endovascular treatment included active extravasation or pseudoaneurysm on contrast-enhanced computed tomography and decrease in hemoglobin level or temporary hemodynamic instability. RESULTS: Arterial injuries were secondary to penetrating injury due to gunshot wound in 4 patients and stab wound in 5, and blunt abdominal injury as result of traffic accident in 3 patients. Traumatic lesions were in the right hepatic artery (n=3), left hepatic (n=2), right hepatic and right renal (n=1), left inferior epigastric (n=2), left facial (n=1), anterior tibial (n=1), and deep femoral (n=1) arteries. Technical success with no procedural complications was seen in all cases. Two patients died due to coexisting injuries on 29th and 43rd days of hospitalization. Median hospitalization period was 6.0 days (range: 1-43 days) and mean intensive care unit hospitalization was 7.7 days (range: 0-43 days). CONCLUSION: In our experience, endovascular treatment was a safe and effective option for acute traumatic peripheral and visceral arterial lesions.

Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension.

AIM: To determine the outcomes of partial splenic embolization (PSE) for massive splenomegaly due to idiopathic portal hypertension (IPH). METHODS: In this prospective study, we evaluated the characteristics and prognosis of consecutive patients with IPH who underwent PSE for all indications at a single medical center between June 2009 and January 2015. The inclusion criteria were: presence of hypersplenism, massive splenomegaly, and resultant pancytopenia. The exclusion criteria were: presence of other diseases causing portal hypertension. During the post-PSE period, the patients were hospitalized. All patients underwent abdominal computed tomography imaging 4 wk post-PSE to determine total splenic and non-infarcted splenic volumes. RESULTS: A total of 11 patients, with median age of 33.27 ± 4.8 years, were included in the study. Mean spleen size was 22.9 cm (21-28 cm), and severe hypersplenism was diagnosed in all patients before PSE. Post-PSE, leukocyte and platelet counts increased significantly, reaching peak levels in the second week with gradual decreases thereafter. Liver function tests did not exhibit significant changes during post-intervention follow-up. All patients developed post-embolization syndrome, and one patient experienced serious complications; all complications were successfully treated with conservative therapy and no death occurred. CONCLUSION: Our findings showed that PSE has a lower complication rate than previously-reported surgical complication rates, which supports this intervention as a viable alternative for high-risk operable patients with severe hypersplenism.

Concomitant transarterial and transvenous embolization of a pelvic arteriovenous malformation using a new liquid embolic agent, squid-12 and detachable coils.

We describe a complex congenital pelvic AVM with multiple feeding arteries arising from the side branches of the right internal iliac artery and a single draining vein in a male patient. Concomitant transarterial and transvenous embolization with a new liquid embolic agent Squid-12 and metallic coils enabled a complete embolization at a single session. Squid-12 is composed of ethylene vinyl alcohol copolymers and its lower viscosity makes it a promising agent for the treatment of AVMs. The patient showed prompt resolution of the symptoms and complete devascularization of the AVM lesion was persisted on the 1-month control angiography. The patient was asymptomatic on the 6th month follow-up.

Transarterial chemoembolization for treatment of hepatocellular carcinoma: A single center experience.

BACKGROUND/AIMS: We aimed to determine the effect of transarterial chemoembolization treatment on survival in patients with hepatocellular carcinoma and to investigate the efficacy and tolerability of two different transarterial chemoembolization procedures, conventional transarterial chemoembolization and drug-eluting beads, in these patients. MATERIALS AND METHODS: A total of 40 patients with hepatocellular carcinoma treated with transarterial chemoembolization between January 2007 and March 2011 were included. Thirty-seven patients had Child-Pugh class A and the remaining 3 had class B. Intra-arterial administration of doxorubicin with lipiodol-based conventional transarterial chemoembolization or drug-eluting beads-transarterial chemoembolization was performed. Eighty sessions were performed with a median of 2 sessions. Sixteen patients were treated with conventional transarterial chemoembolization and 11 with drug-eluting beads-based transarterial chemoembolization, and 13 were treated with both treatment procedures in separate sessions. Primary outcome was defined as patient survival after treatment. RESULTS: The median follow-up was 19 months. The median overall survival of patients was 23.2 months. The survival of patients with Child-Pugh class A was significantly better than that of patients with class B (24 vs 6 months, p=0.004). No statistically significant difference in survival was observed between conventional transarterial chemoembolization and drug-eluting beads-based transarterial chemoembolization treatments (p>0.05). Baseline low serum albumin level (p=0.003) and the presence of portal vein thrombosis (p=0.011) negatively affected patient survival. Side effects of conventional transarterial chemoembolization and drug-eluting beads-based transarterial chemoembolization were similar. CONCLUSIONS: Based on the results of this study and in comparison with the findings in the literature, transarterial chemoembolization treatment was seen to improve overall survival and provide better outcome in selected patients with hepatocellular carcinoma. No differences in survival or side effects were observed between the two transarterial chemoembolization treatment modalities.

Applications of the Amplatzer Vascular Plug 4.

The purpose of this study was to present our initial experience with the Amplatzer® Vascular Plug (AVP) 4 in various arterial environments. This material was designed for the embolization of peripheral small vessels using a diagnostic catheter. Herein, the following three procedures using the AVP 4 were described: hemodialysis fistula occlusion as a treatment for the steal phenomenon, gastroduodenal artery embolization prior to liver radioembolization, and vertebral artery embolization for the treatment of subclavian artery pseudoaneurysm and arteriovenous fistula. All of the treated vessels were successfully occluded, and the devices remained in the original locations and configurations during the follow-up period. When compared with the previous generation of vascular plugs, the AVP 4 allows faster and safer procedures with less radiation exposure to the patients and angiography team.

Multidetector CT of bronchial and non-bronchial systemic arteries.

We evaluate the use of multidetector row computed tomography (MDCT) angiography for the depiction of bronchial and non-bronchial systemic arteries (NBSAs), which frequently become enlarged as a secondary finding in a wide array of chronic lung diseases and other diseases that affect the pulmonary vascular system. MDCT angiography has enabled radiologists to provide thin-slice axial images, multi-planar reconstructions, interactive maximum intensity projections, and volume-rendered images to evaluate the origin and course of the abnormal bronchial arteries and enlarged NBSAs that may be the cause of hemoptysis. Embolization of the bronchial arteries is the primary treatment option in patients with massive hemoptysis. Precise localization of the bleeding vessel(s) prior to catheter arteriography not only is the most important factor for prompt and successful embolization but also prevents the recurrence of hemoptysis from missed NBSAs during procedures.