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Genicular Artery Embolization: A Review of Essential Anatomic Considerations

Liu, Shu; Swilling, David; Morris, Elizabeth; Macaulay, William; Golzarian, Jafar; Hickey, Ryan; Taslakian, Bedros
Genicular artery embolization is increasingly recognized as a safe and effective treatment option for symptomatic knee osteoarthritis and recurrent hemarthrosis following total knee arthroplasty. Genicular arteries are an essential vascular supply for the knee joint and demonstrate considerable variability. Familiarity with the anatomy and common variations is critical for pre-procedural planning, accurate target selection, and minimizing adverse events in trans-arterial embolization procedures. This review aims to provide a detailed discussion of the genicular artery anatomy that is relevant to interventional radiologists performing genicular artery embolization.
PMID: 38128722
ISSN: 1535-7732
CID: 5612112

Impact of Transjugular Intrahepatic Shunt Creation on the Gut Microbiota [Letter]

Swilling, David; Patel, Ashini; Jesudian, Arun B; Laville, Martin; Hickey, Ryan; Taslakian, Bedros; Sista, Akhilesh K
PMID: 38081450
ISSN: 1535-7732
CID: 5589112

Genicular Artery Embolization for Treatment of Knee Osteoarthritis: Interim Analysis of a Prospective Pilot Trial Including Effect on Serum Osteoarthritis-Associated Biomarkers

Taslakian, Bedros; Swilling, David; Attur, Mukundan; Alaia, Erin F; Kijowski, Richard; Samuels, Jonathan; Macaulay, William; Ramos, Danibel; Liu, Shu; Morris, Elizabeth M; Hickey, Ryan
PURPOSE/OBJECTIVE:To characterize the safety, efficacy, and potential role of genicular artery embolization (GAE) as a disease-modifying treatment for symptomatic knee osteoarthritis (OA). MATERIALS AND METHODS/METHODS:This is an interim analysis of a prospective, single-arm clinical trial of patients with symptomatic knee OA who failed conservative therapy for greater than 3 months. Sixteen patients who underwent GAE using 250-μm microspheres and had at least 1 month of follow-up were included. Six patients completed the 12-month follow-up, and 10 patients remain enrolled. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was evaluated at baseline and at 1, 3, and 12 months. Serum and plasma samples were collected for biomarker analysis. The primary end point was the percentage of patients who achieved the minimal clinically important difference (MCID) for WOMAC pain score at 12 months. Baseline and follow-up outcomes were analyzed using the Wilcoxon matched-pairs signed-rank test. RESULTS:Technical success of the procedure was 100%, with no major adverse events. The MCID was achieved in 5 of the 6 (83%) patients at 12 months. The mean WOMAC pain score decreased from 8.6 ± 2.7 at baseline to 4.9 ± 2.7 (P = .001), 4.4 ± 2.8 (P < .001), and 4.7 ± 2.7 (P = .094) at 1, 3, and 12 months, respectively. There was a statistically significant decrease in nerve growth factor (NGF) levels at 12 months. The remaining 8 biomarkers showed no significant change at 12 months. CONCLUSIONS:GAE is a safe and efficacious treatment for symptomatic knee OA. Decreased NGF levels after GAE may contribute to pain reduction and slowing of cartilage degeneration.
PMID: 37640104
ISSN: 1535-7732
CID: 5611392

Genicular artery embolization for treatment of knee osteoarthritis pain: Systematic review and meta-analysis

Taslakian, Bedros; Miller, Larry E.; Mabud, Tarub S.; Macaulay, William; Samuels, Jonathan; Attur, Mukundan; Alaia, Erin F.; Kijowski, Richard; Hickey, Ryan; Sista, Akhilesh K.
Objective: Genicular artery embolization (GAE) is a novel, minimally invasive procedure for treatment of knee osteoarthritis (OA). This meta-analysis investigated the safety and effectiveness of this procedure. Design: Outcomes of this systematic review with meta-analysis were technical success, knee pain visual analog scale (VAS; 0"“100 scale), WOMAC Total Score (0"“100 scale), retreatment rate, and adverse events. Continuous outcomes were calculated as the weighted mean difference (WMD) versus baseline. Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) rates were estimated in Monte Carlo simulations. Rates of total knee replacement and repeat GAE were calculated using life-table methods. Results: In 10 groups (9 studies; 270 patients; 339 knees), GAE technical success was 99.7%. Over 12 months, the WMD ranged from −34 to −39 at each follow-up for VAS score and −28 to −34 for WOMAC Total score (all p "‹< "‹0.001). At 12 months, 78% met the MCID for VAS score; 92% met the MCID for WOMAC Total score, and 78% met the SCB for WOMAC Total score. Higher baseline knee pain severity was associated with greater improvements in knee pain. Over 2 years, 5.2% of patients underwent total knee replacement and 8.3% received repeat GAE. Adverse events were minor, with transient skin discoloration as the most common (11.6%). Conclusions: Limited evidence suggests that GAE is a safe procedure that confers improvement in knee OA symptoms at established MCID thresholds. Patients with greater knee pain severity may be more responsive to GAE.
SCOPUS:85162354695
ISSN: 2665-9131
CID: 5549022

Staged Endovascular and Surgical Management of a Mycotic Pseudoaneurysm After Pancreas Transplant [Case Report]

Stern, Jeffrey; Negash, Bruck; Hickey, Ryan; Lugo, Joanelle; Cayne, Neal S; Lonze, Bonnie E; Ali, Nicole M; Stewart, Zoe A
Mycotic pseudoaneurysms are a rare, life-threatening complication after pancreas transplant. There have been limited reports of endovascular treatment of mycotic pseudoaneurysms in pancreas transplant recipients. Herein, we report on a case of a mycotic pseudoaneurysm from Pseudomonas aeruginosa after pancreas transplant. A 53-year-old male recipient underwent an uneventful simultaneous pancreas and kidney transplant. He was readmitted 48 days posttransplant with fevers and rigors. Pan-cultures were performed and broad-spectrum antibiotics were initiated. Imaging studies demonstrated a large mycotic pseudoaneurysm arising from the right common iliac artery adjacent to the arterial Y-graft anastomosis of the transplant pancreas. Endovascular stent placement was used to exclude the pseudoaneurysm prior to transplant pancreatectomy. During pancreatectomy, the lateral wall of the common iliac artery was found to be necrotic with significant exposure of the endovascular stent. After ligation and excision of the common iliac artery, a femorofemoral bypass was performed to revascularize the lower extremity. This case report highlights the advantage of a staged endovascular and surgical management strategy for complex mycotic pseudoaneurysms after pancreas transplant.
PMID: 36919726
ISSN: 2146-8427
CID: 5448882

MRI-Derived Sarcopenia Associated with Increased Mortality Following Yttrium-90 Radioembolization of Hepatocellular Carcinoma

Guichet, Phillip L; Taslakian, Bedros; Zhan, Chenyang; Aaltonen, Eric; Farquharson, Sean; Hickey, Ryan; Horn, Cash J; Gross, Jonathan S
PURPOSE/OBJECTIVE:Y radioembolization. MATERIALS AND METHODS/METHODS:for women. Survival at 90 days, 180 days, 1 year, and 3 years following initial treatment was assessed using medical and public obituary records. RESULTS:Sarcopenia was identified in 30% (25/82) of patients. Death was reported for 49% (32/65) of males and 71% (8/17) of females (mean follow-up 19.6 months, range 21 days-58 months). Patients with sarcopenia were found to have increased mortality at 180 days (31.8% vs. 8.9%) and 1 year (68.2% vs. 21.2%). Sarcopenia was an independent predictor of mortality adjusted for BCLC stage and sub-analysis demonstrated that sarcopenia independently predicted increased mortality for patients with BCLC stage B disease. CONCLUSION/CONCLUSIONS:Y radioembolization. Sarcopenia was an independent predictor of survival adjusted for BCLC stage with significant deviation in the survival curves of BCLC stage B patients with and without sarcopenia.
PMID: 34089074
ISSN: 1432-086x
CID: 4899312

Radioembolization in the Setting of Systemic Therapies

Mabud, Tarub S; Hickey, Ryan
PMCID:8497089
PMID: 34629716
ISSN: 0739-9529
CID: 5067922

The Role of the Interventional Radiologist in Bile Leak Diagnosis and Management

Zhu, Yuli; Hickey, Ryan
Bile leaks are rare but potentially devastating iatrogenic or posttraumatic complications. This is being diagnosed more frequently since the advent of laparoscopic cholecystectomy and propensity toward nonsurgical management in select trauma patients. Timely recognition and accurate characterization of a bile leak is crucial for favorable patient outcomes and involves a multimodal imaging approach. Management is driven by the type and extent of the biliary injury and requires multidisciplinary cooperation between interventional radiologists, endoscopists, and hepatobiliary/transplant surgeons. Interventional radiologists have a vital role in both the diagnosis and management of bile leaks. Percutaneous interventional procedures aid in the characterization of a bile leak and in its initial management via drainage of fluid collections. Most bile leaks resolve with decompression of the biliary system which is routinely done via endoscopic retrograde cholangiopancreaticography. Some bile leaks can be definitively treated percutaneously while others necessitate surgical repair. The primary principle of percutaneous management is flow diversion away from the site of a leak with the placement of transhepatic biliary drainage catheters. While this can be accomplished with relative ease in some cases, others call for more advanced techniques. Bile duct embolization or sclerosis may also be required in cases where a leaking bile duct is isolated from the main biliary tree.
PMCID:8354731
PMID: 34393341
ISSN: 0739-9529
CID: 4988902

Comparing Real World, Personalized, Multidisciplinary Tumor Board Recommendations with BCLC Algorithm: 321-Patient Analysis

Matsumoto, Monica M; Mouli, Samdeep; Saxena, Priyali; Gabr, Ahmed; Riaz, Ahsun; Kulik, Laura; Ganger, Daniel; Maddur, Haripriya; Boike, Justin; Flamm, Steven; Moore, Christopher; Kalyan, Aparna; Desai, Kush; Thornburg, Bartley; Abecassis, Michael; Hickey, Ryan; Caicedo, Juan; Grace, Karen; Lewandowski, Robert J; Salem, Riad
PURPOSE/OBJECTIVE:To evaluate hepatocellular carcinoma (HCC) treatment allocation, deviation from BCLC first-treatment recommendation, and outcomes following multidisciplinary, individualized approach. METHODS:Treatment-naïve HCC discussed at multidisciplinary tumor board (MDT) between 2010 and 2013 were included to allow minimum 5 years of follow-up. MDT first-treatment recommendation (resection, transplant, ablation, transarterial radioembolization (Y90), transarterial chemoembolization, sorafenib, palliation) was documented, as were subsequent treatments. Overall survival (OS) analyses were performed on an intention-to-treat (ITT) basis, stratified by BCLC stage. RESULTS:Three hundred and twenty-one patients were treated in the 4-year period. Median age was 62 years, predominantly male (73%), hepatitis C (41%), and Y90 initial treatment (52%). There was a 76% rate of BCLC-discordant first-treatment. Median OS was not reached (57% alive at 10 years), 51.0 months, 25.4 months and 13.4 months for BCLC stages A, B, C and D, respectively. CONCLUSION/CONCLUSIONS:Deviation from BCLC guidelines was very common when individualized, MDT treatment recommendations were made. This approach yielded expected OS in BCLC A, and exceeded general guideline expectations for BCLC B, C and D. These results suggest that while guidelines are helpful, implementing a more personalized approach that incorporates center expertise, patient-specific characteristics, and the known multi-directional treatment allocation process, improves patient outcomes.
PMID: 33825060
ISSN: 1432-086x
CID: 5191572

Revenue Sources in Interventional Radiology: Revenue Analysis of an Interventional Oncology Service Line [Letter]

Chong, Anthony T; Ruohoniemi, David M; Aaltonen, Eric T; Horn, Jeremy Cash; Sista, Akhilesh K; Taslakian, Bedros; Hickey, Ryan M
PMID: 33640515
ISSN: 1535-7732
CID: 4800992