MRI-Derived Sarcopenia Associated with Increased Mortality Following Yttrium-90 Radioembolization of Hepatocellular Carcinoma
PURPOSE/OBJECTIVE:Y radioembolization. MATERIALS AND METHODS/METHODS:for women. Survival at 90Â days, 180Â days, 1Â year, and 3Â 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 19.6Â months, range 21Â days-58Â months). Patients with sarcopenia were found to have increased mortality at 180Â days (31.8% vs. 8.9%) and 1Â 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.
Muscle mass on magnetic resonance imaging predicts hepatocellular carcinoma survival following Yttrium-90 radioembolization [Meeting Abstract]
Purpose: To assess the impact of muscle mass on survival in patients with hepatocellular carcinoma undergoing yttrium-90 radioembolization. Materials: The medical records of 186 patients undergoing Yttrium-90 radioembolization for hepatocellular carcinoma between April 2014 and May 2017 were retrospectively reviewed. Fifty patients with an abdominal MRI performed within 90 days prior to treatment were identified. All patients underwent standardized abdominal and liver MRI sequence protocols. Axial T2-weighted fat-suppressed sequences were used for image analysis. The paraspinal musculature was manually segmented at the level of the origin of the superior mesenteric artery using syngo.via (Siemens Healthineers, USA) and used to calculate skeletal muscle area (cm2) and skeletal muscle index (cm2/m2). Sarcopenia was defined as skeletal muscle area < 35.23 cm2 for men and < 31.53 cm2 for women. Medical records were reviewed to determine patient survival following treatment. Descriptive statistics, including Mann-Whitney tests and receiver operating characteristic curves, were performed.
Result(s): Fifty patients (86% male) with mean age 64 years (range, 31-83 years) met inclusion criteria. Death was reported for 49% (21/43) of male and 57% (4/7) of female patients, with average follow-up of 21 months (range, 0.7-56 months). Sarcopenia was identified in 16% (7/43) of male and 29% (2/7) of female patients. There were statistically significant differences in skeletal muscle area (48.72 +/- 12.01 cm2 vs. 42.18 +/- 15.13 cm2) (P = 0.047) and skeletal muscle index (16.26 +/- 2.69 cm2/m2 vs. 14.56 +/- 5.83 cm2/m2) (P = 0.024) between men who survived and died. Differences for the seven female patients included in the study did not achieve statistical significance, likely due to small sample size. Median survival was estimated as 1403 days for nonsarcopenic men (36/43) and 243 days for sarcopenic men (7/43) (P = 0.272).
Conclusion(s): Muscle mass on pre procedure MRI predicts survival in patients with hepatocellular carcinoma undergoing Yttrium-90 radioembolization. Sarcopenia may be associated with shorter survival and ongoing analysis of additional patients will improve study power to detect significant differences.
Gonadal vein embolization for treatment of symptomatic varicocele [Meeting Abstract]
Purpose: To evaluate the technical success, clinical efficacy, and safety of gonadal vein embolization in men presenting with symptomatic varicoceles. Materials: A retrospective study of 83 consecutive male patients who had varicocele embolization between January 2008 and December 2018 was conducted. 39 patients (mean age, 33.8 years; range, 18-70 years) met the inclusion criteria of symptomatic varicocele (scrotal pain and/or heaviness) and had complete clinical records. The primary outcome was symptomatic improvement. Secondary outcomes were technical success rate defined as successful catheterization and embolization of the gonadal vein(s) and adverse events.
Result(s): Of the 39 patients, 33 (84.6%) presented had scrotal pain, 3 (7.7%) had heaviness, and 3 (7.7%) had pain and heaviness. Nine (23.1%) had prior varicocelectomy. 32 patients had complete preprocedural ultrasound; of those 12 (37.5%) had testicular asymmetry, 22 (68.8%) had left varicocele, 1 (3.1%) had right varicocele, and 9 (28.1%) had bilateral varicoceles. Procedural approach was transfemoral in 34 (87.2%) and transjugular in 5 (12.8%) patients. Only symptomatic sides were treated; of the 39 patients, 8 (20.5%) had bilateral, 1 (2.6%) had right, and 30 (76.9%) had left embolization. Embolic agents used were coils + Sodium tetradecyl sulfate (STS) in 3 (7.7%), coils + n-Butyl cyanoacrylate (n-BCA) glue in 8 (20.5%), n-BCA glue alone in 20 (51.3%), and a combination of different embolization material in the remainder of the patients (STS, vascular plugs, n-BCA, Gelfoam, and/or coils). The mean time to follow-up was 8.3 months. The overall technical success rate was 94.9%; of those, 28 (75.7%) indicated an improvement in their preprocedural symptoms. In patients with symptomatic improvement, the recurrence rate was 7.1%, with a mean time to recurrence of 7.5 months. There were no recorded complications. Conclusion(s): GVE is safe, has high technical success rate, and is effective in improving scrotal pain and heaviness
Left-to-left TIPS [Meeting Abstract]
Learning Objectives: 1. Describe anatomic and physiologic aspects of creating left hepatic vein (LHV) to left portal vein (LPV) transjugular intrahepatic portosystemic shunts (TIPS). 2. Illustrate through a series of 15 cases the technical aspects unique to left-sided TIPS. 3. Understand outcomes of left-to-left TIPS creation for refractory ascites and variceal bleeding, compared with right and middle hepatic vein and right portal vein TIPS Background: TIPS creation is a primary treatment for complications of portal hypertension. Classically, the shunt is created between the right hepatic and right portal veins, owing to the relatively larger size of the right hepatic lobe that would theoretically increase safety and the potential for accessing one of multiple portal venous branches. LHV to LPV TIPS is much less frequently done, though preliminary studies have suggested possibly increased safety. In addition, there may be specific indications for left to left TIPS, most of which are anatomic in nature Clinical Findings/Procedure Details: Fifteen patients underwent successful LHV to LPV TIPS creation at a single institution from 11/2011 to 12/2014. Through a series of examples, the anatomy of left-to-left TIPS creation will be reviewed: left-sided TIPS tend to be shorter and less angulated compared with right-sided TIPS. Given the shorter trajectory, use of a pediatric needle for access may be considered. Patient outcomes regarding control of ascites and bleeding will be reviewed. Only 2 of 15 patients (13%) required a revision with angioplasty or further stent placement over 6 months. All of the patients were alive at 1 month post-TIPS. Conclusions: Left hepatic to left portal vein TIPS creation is safe and provides comparable outcomes compared with right-sided TIPS. Future controlled trials in centers frequently performing TIPS creation could clarify which approach is optimal. However, familiarity with the technical aspects of left-sided TIPS creation is essential as many patients have anatomy unfavorable for right-sided TIPS
Unexpected Angiography Findings and Effects on Management
Despite progress in noninvasive imaging with computed tomography and magnetic resonance imaging, conventional angiography still contributes to the diagnostic workup of oncologic and other diseases. Arteriography can reveal tumors not evident on cross-sectional imaging, in addition to defining aberrant or unexpected arterial supply to targeted lesions. This additional and potentially unanticipated information can alter management decisions during interventional procedures.
Bronchial Artery Embolization
[Cham], Switzerland : Springer, 
[Cham], Switzerland : Springer, 
Pulmonary Artery Thrombectomy and Thrombolysis
[Cham], Switzerland : Springer, 
Transjugular intrahepatic portosystemic shunt (TIPS) creation for refractory ascites: Post-TIPS gradient best predictor of clinical outcome [Meeting Abstract]
Purpose: TIPS creation fails to control ascites in 40% or more of patients, but the variables predicting outcome are unclear, with prior studies highlighting pre-TIPS portosystemic gradient (PSG) (Nair et al 2004; JVIR 15:1431). We studied which variables predict outcome of TIPS for refractory ascites. Materials and Methods: We retrospectively identified patients who underwent TIPS for refractory ascites between 1/12 and 5/14, yielding 40 patients. We excluded 17 patients due to insufficient peri-procedural documentation or technical failures, leaving 23 patients (16 men, 7 women, mean age 60 +/-2 yrs) for assessment of variables influencing osmotic (albumin and sodium levels) and hydrostatic (pre- and post- TIPS PSG and large varices) pressure. Responders were defined as those requiring fewer or no paracenteses; nonresponders had persistent ascites, with similar pre-TIPS frequency of therapeutic paracentesis. Complications within 1 month requiring hospitalization were noted. Multiple logistic regression, Mann-Whitney U tests, and one-tailed chi2 tests assessed group differences. Results: Ten patients (43%: responders) had documented improvement in ascites. Multiple logistic regression including pre- and post-TIPS PSG significantly impacted outcome (p=0.04). Post- but not pre-TIPS PSG predicted outcome (p=0.04 vs. p=0.84). Responders had significantly lower post- TIPS gradient (5.8) compared with non-responders (7.6) (p=0.02). In contrast, responders and non-responders did not differ in albumin (2.7 vs. 2.7) or sodium (136 vs. 134) levels, or pre-TIPS gradient (13.9 vs. 14.7 mmHg) (p>0.05). Similar numbers of responders (50%) had large varices compared to non-responders (61%) (p=0.3). Responders (50%) had significantly more complications compared to non-responders (15%) (p=0.04), mostly encephalopathy (85%) requiring hospitalization. Conclusion: Only post-TIPS PSG predicted which patients had significantly reduced ascites, in contrast to prior studies suggesting importance of pre-TIPS gradient. Findings suggest aggressively lowering the gradient below 6 mmHg may be the most reliable technique to improve outcomes, although with expected higher risk of complications
Denali, ALN, and Option/Option Elite filter retrieval: A single center experience [Meeting Abstract]
Purpose: To evaluate if there is a significant difference in retrieval difficulty as determined by fluoroscopy time and equipment use when comparing three different filters: Denali, ALN, and Option/Option Elite. Materials and Methods: Retrospective analysis was performed of 33 filter retrievals performed over a 24 month period (12 men, 21 women; mean age 60). There were 8 Denali (Bard Peripheral Vascular), 9 ALN (ALN Implants), and 16 Option/ Option Elite (Argon Medical Devices) filter retrievals. Demographics, filter dwell time, fluoroscopy time during retrieval, and equipment used for retrieval were collected for each case. One Option case was excluded due to unsuccessful retrieval. Kruskal-Wallis H, two sample t-test and Chi-square analysis were used to determine significant differences in fluoroscopy time and equipment use between the three filter groups. Results: There were no significant differences between groups based on demographics or filter dwell time. Mean retrieval times were 4.9 min (SD: 3.6, range 1.2-10.3) for Denali, 9.9 min (SD: 5.5, range 2.9-18.6) for ALN, and 23.9 min (SD: 20.0, range 2.5 - 58) for Option/Option Elite. A Kruskal-Wallis H test showed a significant difference in these times (chi2=7.17, p=0.028), subsequent post-hoc analysis showed a significant difference only between Denali and Option but not between Denali and ALN or ALN and Option. Given normal distribution of fluoroscopy times for Denali and ALN, a separate t-test comparing these two filters did demonstrate a significant difference in fluoroscopy time (p=0.023). None of the Denali retrievals required additional equipment beyond a snare and sheath, 1/9 (11%) of ALN and 10/15 (67%) of Option retrievals required at least a tip deflecting wire or angled catheter (chi2=11.07, p=0.004). Sub-analysis separating Option and Option Elite filters did not change any results significantly. Conclusion: Denali filter retrieval involves significantly less fluoroscopy time than ALN or Option/Option Elite filter retrieval. In this series, Option/Option Elite retrieval also required significantly more equipment to achieve technical success compared to Denali and ALN retrieval. A larger sample size is required to corroborate these early results. (Table Presented)