Notes

Genetics Harm Response inside the Adaptable Supply of the Immune System: Significance regarding Autoimmunity.
Alternative or subsequent interventions vary by anatomical site and may require additional multidisciplinary team input. For a stenoses recurring between 3 and 12months, it is appropriate to consider interventions used de novo, but with a lower threshold for using drug-coated balloons (DCBs) in all regions and for using stent grafts in all regions but inflow segment. Recurrence after 12months should be treated as a de novo lesion, with DCBs considered if they have been used successfully during previous interventions.

These recommendations aim to provide a practical guide to multidisciplinary teams in order to optimise the use of multiple interventions for rectifying AVF stenoses and provide unified evidence-based practice guidelines.
These recommendations aim to provide a practical guide to multidisciplinary teams in order to optimise the use of multiple interventions for rectifying AVF stenoses and provide unified evidence-based practice guidelines.As the field of interventional radiology assumes a larger role in patient care, the specialty has a growing responsibility to recognize and understand ethical dilemmas within the field. We present a case-based primer on common ethical issues in IR, including requests for potentially inappropriate procedures, surrogate decision making, informed consent, and managing conflicts of interest and procedural complications. This primer is intended to be used as a guide for discussion-based training in ethics in IR while inspiring further research in applied ethics in IR.
This animal experimental study evaluated how hepatic artery and portal vein transient occlusion affects the ablation zone of hepatic radiofrequency ablation (RFA).

Twenty-one rabbits were divided into three groups of seven each (1) control, (2) hepatic artery occlusion, and (3) portal vein occlusion by a balloon catheter. ABT-199 For each rabbit, two or three RFA sessions were performed using an electrode needle. Ablation time, temperature around the tip of RFA needle at the end of RFA, ablation volume on fat-suppressed T1-weighted image in the hepatobiliary phase, and coagulative necrosis area on histopathology were measured and compared between the three groups using the Kruskal-Wallis paired Mann-Whitney U tests.

In 43 RFA sessions (group 1, 15; group 2, 14; group 3, 14), mean tissue temperature in group 3 (77.0°C ± 7.7°C) was significantly higher compared to groups 1 (59.2°C ± 18.8°C; P = 0.010) and 2 (67.5°C ± 9.9°C; P = 0.010). In addition, mean ablation volume and coagulative necrosis in group 3 (2.10 ± 1.37 mm
and 0.86 ± 0.28 mm
, respectively) were larger compared to groups 1 (0.84 ± 0.30 mm
; P < 0.001 and 0.55 ± 0.26 mm
; P = 0.020, respectively) and 2 (0.89 ± 0.59 mm
; P = 0.002 and 0.60 ± 0.22 mm
; P = 0.024, respectively).

Portal vein occlusion potentially boosts tissue temperature, ablation volume, and area of histopathologically proven coagulative necrosis during hepatic RFA in the non-cirrhotic liver.
Portal vein occlusion potentially boosts tissue temperature, ablation volume, and area of histopathologically proven coagulative necrosis during hepatic RFA in the non-cirrhotic liver.
To examine the safety and efficiency of balloon-assisted gastrostomy for insertion of large bore feeding tubes compared to conventional techniques using dilators.

Retrospective review of all fluoroscopically guided percutaneous gastrostomy tube insertions between July 2017 and September 2019 was performed. Collected data points included patient demographics, initial pathology, type of gastrostomy tube (G tube) inserted [(Avanos standard balloon retained (Mic-G), or low-profile balloon retained (Mic-Key)], type of insertion technique (balloon-assisted or -nested dilator technique), fluoroscopy time, amount of sedation required, technical success, and complications. The focus of the study was method of tract dilatation - either balloon-assisted gastrostomy (BAG group) versus nested or sequential dilators (dilator group). Two hundred patients were included in this study; 100 patients were evaluated in each group.

There were no significant differences between the two groups. The overall rate of minor complications (grades 1 and 2, according to the CIRSE classification system) was higher in the dilator group (11%, compared to 7% in the BAG group) but did not reach statistical significance. Males were associated with lower risk of minor complications (OR 0.19, 95% CI (0.07, 0.53)), while age did not present a significant association. Patients in the BAG group received a significantly lower amount of fentanyl (p < 0.001) and midazolam (p < 0.001) than patients in the dilator group.

Balloon-assisted gastrostomy is a safe and effective technique for large bore gastrostomy placement. Patients required less sedation, allowing for faster recovery and discharge time in outpatients at our institution.
Balloon-assisted gastrostomy is a safe and effective technique for large bore gastrostomy placement. Patients required less sedation, allowing for faster recovery and discharge time in outpatients at our institution.
To determine the pathologic response of computed tomography-guided percutaneous microwave ablation as bridging therapy for patients with hepatocellular carcinoma awaiting liver transplant, and its subsequent effect on survival.

A single-center retrospective analysis was conducted on 62 patients (MF = 5012) with mean age of 59.6years ± 7.2months (SD). Sixty-four total MWA procedures were performed for hepatocellular carcinomas within Milan criteria as bridging therapy to subsequent orthotopic liver transplant between August 2014 and September 2018. The pathology reports of the explanted livers were reviewed to assess for residual disease. Residual disease was categorized as complete or incomplete necrosis. Patient demographics, tumor/procedural characteristics, and laboratory values were evaluated. Survival from time of ablation and time of transplantation were recorded and compared between cohorts using log rank tests.

The mean tumor size was 2.4cm ± 0.7cm (SD), (range = 1-4.6cm). 32 (50%) cases required hydrodissection. Histopathologic necrosis was seen in 66% of cases at time of liver transplantation. Median time to liver transplant post-MWA was 12.6months. [IQR = 8.6-14.8months]. The median survival from ablation was 60.8months [IQR = 45.5-73.7months], and the median survival from transplant was 49.3months [IQR = 33.7-60.1months]. There was no significant difference in survival for patients with complete versus incomplete necrosis from ablation or liver transplant (p = 0.49, p = 0.46, respectively).

Computed tomography-guided percutaneous microwave ablation is an effective bridge to orthotopic liver transplantation for patients with hepatocellular carcinoma.

Level 3, non-randomized controlled cohort study/follow-up study.
Level 3, non-randomized controlled cohort study/follow-up study.
Interventional radiology (IR) has come a long way to a nowadays UEMS-CESMA endorsed clinical specialty. Over the last decades IR became an essential part of modern medicine, delivering minimally invasive patient-focused care.

To provide principles for delivering high quality of care in IR.

Systematic description of clinical skills, principles of practice, organizational standards and infrastructure needed for the provision of professional IR services.

There are IR procedures for almost all body parts and organs, covering a broad range of medical conditions. In many cases IR procedures are the mainstay of therapy, e.g. in the treatment of hepatocellular carcinoma. In parallel the specialty moved from the delivery of a procedure towards taking care for a patient's condition with the interventional radiologists taking ultimate responsibility for the patient's outcomes.

The evolution from a technical specialty to a clinical specialty goes along with changing demands on how clinical care in IR is provided. The CIRSE Clinical Practice Manual provides interventional radiologist with a starting point for developing his or her IR practice as a clinician.
The evolution from a technical specialty to a clinical specialty goes along with changing demands on how clinical care in IR is provided. The CIRSE Clinical Practice Manual provides interventional radiologist with a starting point for developing his or her IR practice as a clinician.
This study analysed the progression of proximal aortic neck diameter in patients with asymptomatic abdominal aortic aneurysms, treated by endovascular aortic repair using four different, contemporary types of endograft.

This is a retrospective study of four cohorts of 30 patients presenting with asymptomatic abdominal aortic aneurysms and treated with endovascular aortic repair using four different types of contemporary endografts, namely Endurant® (Medtronic), Excluder® (W.L. Gore), Zenith® (Cook Medical) and Ovation® (Endologix) endografts. Patients' demographics and aortic aneurysm measurements, including suprarenal aortic, proximal infrarenal neck and maximum aortic aneurysmal diameter, were gathered from the patients' electronic medical records, pre- and post-interventional computed tomography studies, respectively. Diameter measurements were modelled as a function of endograft type; an interaction test was used to test whether the evolutions over time were different between the four types of endograft.

Suprarenal aortic diameter increased over time (P = 0.0235) and maximum aortic aneurysm diameter decreased over time (P = 0.0008) in the four types of endograft. The progressive increase in proximal neck diameter from preoperative baseline up to five years of follow-up was 1.20mm for Endurant (P = 0.0054), 1.72mm for Ovation (P = 0.0006), 1.14mm for Excluder (P = 0.0102) and 2.83mm for Zenith (P < 0.0001), respectively. Five patients (4%) presented with a late-type 1a endoleak Endurant (n = 1); Ovation (n = 2) and Zenith (n = 2).

All endografts were associated with a progressive dilatation of the proximal aortic neck over a time interval of five years and may be associated with late-type 1a endoleak.
All endografts were associated with a progressive dilatation of the proximal aortic neck over a time interval of five years and may be associated with late-type 1a endoleak.
To compare the recanalization of the uterine arteries and uterine necrosis after uterine artery embolization (UAE) using either soluble gelatin sponge particles (SGS), which dissolve in saline, or tris-acryl gelatin microspheres (MS), which are permanent embolic materials, in swine.

Fourteen uteri in seven swine were divided into two groups for embolization with either 500-1000µm SGS (SGS group) or 500-700µm MS (MS group) (seven uteri per group). The uterine arteries were embolized using SGS or MS, and angiography was performed to evaluate recanalization of the uterine arteries immediately, 1, 2, 3, 4, 5, and 6h, and 3days after embolization. On day 3, the uteri were removed to determine the macroscopic necrosis rate and for histopathologic examination.

In the SGS group, four uterine arteries were completely recanalized, two were partially recanalized, and one was still occluded 5h after embolization. In contrast, all seven uterine arteries in the MS group were still occluded 6h after embolization. The complete recanalization rate at 3days was significantly greater in the SGS group than in the MS group (100.
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