搜索结果：Journal of vascular and interventional radiology : JVIR

To examine the cost implications of intravascular ultrasound (US) in lower extremity deep venous intervention. This retrospective cohort study analyzed Medicare claims data from 2016 to 2021 for beneficiaries aged ≥65 years undergoing lower extremity venous interventions. Gamma regression adjusted for demographics and comorbidities assessed cost ratios for intravascular US-guided versus non-intravascular US-guided procedures standardized to duration of follow-up. Rates of rehospitalization for causes attributable to complications of intervention were compared between intravascular US-guided and non-intravascular US-guided procedures by Cox regression. Results are shown as estimates with 95% CIs. Among 52,610 patients, 42.6% underwent intravascular US-guided procedures including stent placement, thrombolysis, or thrombectomy. Intravascular US use was highest in outpatient settings (75.3%) and ambulatory surgical center (ASC)/office-based laboratory (OBL; 86.4%) and lowest in inpatient settings (10.4%). In all settings, intravascular US use was associated with cost savings. In the inpatient setting, intravascular US guidance was associated with a cost ratio of 0.91 (95% CI, 0.88-0.95) at 90 days, compared with 0.71 (95% CI, 0.68-0.73) in ASC/OBL and 0.73 (95% CI, 0.71-0.76) in hospital-based outpatient settings. Cost savings persisted at 1- and 3-year follow-ups. Intravascular US guidance was associated with lower 1-year complication-related hospitalization in outpatient procedures (hazard ratio [HR], 0.73; 95% CI, 0.62-0.86) and ASC/OBL procedures (HR, 0.78; 95% CI, 0.66-0.91). Cost savings were present in stent placement procedures at 90 days (cost ratio, 0.71; 95% CI, 0.68-0.73), whereas there was cost neutrality in thrombectomy (cost ratio, 1.02; 95% CI, 0.97-1.08) and thrombolysis (cost ratio, 0.89; 95% CI, 0.75-1.05). Intravascular US-guided venous intervention was associated with durable cost savings and reductions in rehospitalization in all procedural settings among procedures involving stent deployment.

To elucidate the influence of whole blood viscosity (WBV) on sac shrinkage as well as Type 2 endoleaks (T2ELs), reinterventions, and prognosis after endovascular aneurysm repair (EVAR). This was a single-center retrospective cohort study. Patients who underwent elective index EVAR between 2007 and 2022 and had postoperative follow-up of &#x2265;1 year were reviewed. WBV was estimated using de Simone formula. The primary endpoint was sac shrinkage (&#x2265;5 mm decrease) after EVAR, and the secondary endpoints were the incidence of T2EL, reinterventions for sac expansion, and overall survival. Using receiver operating characteristics analysis, a cutoff value of WBV for sac shrinkage was determined. Of 286 patients, sac shrinkage occurred in 154 (53.8%). Multivariate analysis revealed that WBV level, absence of hostile neck anatomy, and presence of circumferential thrombus were predictors of sac shrinkage. The cutoff value of WBV for sac shrinkage was 44.0 cP. The study cohort was divided into 2 groups: a high-WBV group (WBV &#x2265; 44.0 cP) and a low-WBV group (WBV < 44.0 cP). The high-WBV group showed a higher sac shrinkage rate (P < .001), lower incidence of T2EL (P = .021), fewer reintervention for sac expansion (P = .038), and higher overall survival (P = .023) than the low-WBV group. WBV is a positive predictor of sac shrinkage, and elevated WBV is associated with durable success, including a low incidence of T2EL and reintervention for sac expansion after EVAR, without a detrimental effect on prognosis.

To compare the in vitro effects of filters and ethiodized oil (EO) on the stability and component cost of sodium tetradecyl sulfate (STS) foam, emphasizing foam quality during a clinically relevant injection window. Eleven foaming methods using 2 mL of 3% STS and air were evaluated in 9 replicates. Variables included stroke number (10 and 20), air volume (2 and 8 mL), filter pore size (0.2 and 5 &#x3bc;m), and EO volume (0.2 and 1.0 mL). Quarter-life (T&#xbc;), half-life (T&#xbd;), and foamed volume at 120 seconds were recorded. The primary endpoint was T&#xbc; &#x2265; 30 seconds, defined as &#x2265;75% of STS remaining in foam form within 30 seconds. Component cost and microscopic morphology were compared. All methods met the injection window criterion. Control (STS-to-air ratio, 1:1) had the lowest stability (T&#xbc;, 47 s; T&#xbd;, 73 s). The 0.2-&#x3bc;m filter improved stability (T&#xbc;, 68 s; T&#xbd;, 104 s), whereas 1.0-mL EO extended T&#xbc; and T&#xbd; beyond 120 seconds. T&#xbc; gains were similar for the 0.2-&#x3bc;m filter and 0.2-mL EO, with filter cost <1% of EO. Air volume and stroke number had minimal impact. EO and filters enhanced STS foam stability, with EO producing the strongest effect. All foaming methods met the benchmark delivery of &#x2265;75% foamed STS within 30 seconds. Filters provide a practical option that may reduce cost and avoid unresolved questions regarding potential EO effects on STS bioactivity and in vivo phase separation.

To assess clinical maturation rates after assisted percutaneous transluminal angioplasty (PTA) of immature autogenous arteriovenous fistulas (AVFs) and to identify patient and lesion characteristics associated with maturation. Consecutive patients with immature AVFs undergoing PTA (July 2018-December 2022) were retrospectively included. Clinical maturation (primary endpoint) was defined as successful two-needle cannulation in &#x2265;75% of sessions over 4 consecutive weeks within 12 months post-PTA, assessed from dialysis records at 3-month intervals. Patency outcomes were prospectively recorded per Society of Interventional Radiology standards. Multivariable logistic regression adjusted for age, Katz ADL disability, occlusion, number of stenoses, arterial stenosis, and reference vessel diameter; subgroup analyses were prespecified by age (>75 vs &#x2264;75 years) and number of stenoses (single vs multiple). Among 156 patients (mean age 65 &#xb1; 13 years; 58% male), technical success was 99% (154/156). Cumulative clinical maturation was 58%, 66%, 74%, and 76% at 3, 6, 9, and 12 months, respectively. Twelve-month primary, assisted-primary, and secondary patency were 49%, 80%, and 87%. In the multivariable model, age >75 years (OR 4.90, 95% CI 1.50-15.06; P=0.01), severe disability (OR 3.12, 95% CI 1.12-8.69; P=0.03), and multiple stenoses (OR 2.89, 95% CI 1.16-7.20; P=0.02) independently predicted non-maturation. Treatment of immature AVFs with technically successful PTA can enable successful hemodialysis use in a substantial proportion of patients, although patency does not always translate into consistent usability. Both patient condition (age, disability) and lesion characteristics (number of stenoses) were independently associated with clinical maturation after PTA.

To identify patients with increased dialysis access management interventions, assess patterns of use, and examine socioeconomic factors predicting increased procedural recurrence. Retrospective chart reviews of patients who underwent dialysis intervention procedures at a safety-net hospitals (SNHs) and tertiary care centers (TCCs) between 2019 and 2024 were conducted. "Early reintervention patients," defined as patients who underwent 2 or more procedures within a 90-day period, were identified. Demographic and procedural details were collected. Independent t-tests for continuous variables and chi-square tests for categorical variables were used to compare early versus nonearly reintervention patients. Multivariate analysis was performed with multiple logistic regression to identify independent predictors of early reintervention. The study included 410 patients, with 193 from the TCC and 217 from the SNH. SNH had 107 early reintervention patients (49%), and the TCC had 88 early reintervention patients (46%). The 2 sites had statistically significant differences in sex, race, primary language, and insurance type. Black/African American (32%) and Asian (26.2%) patients were the 2 dominant racial groups of early reintervention patients. Arteriovenous (AV) graft (odds ratio [OR], 3.3; P < .0001), nonroutine examinations (STAT [immediately]/urgent/emergent) (OR, 2.32; P < .00018), and public insurance (OR, 1.74; P < .035) were identified as risk factors for early reintervention status. Age, sex, race, language, site of treatment, and procedure time were not statistically significant predictors of early reintervention status. Nonroutine examination order status (STAT/urgent/emergent), public insurance, and the presence of an AV graft were independent predictors of early reintervention.

To compare functional outcomes and procedure-related complication rates between patients with tandem occlusions treated with endovascular thrombectomy plus extracranial internal carotid artery stenting (ES) and those treated with endovascular thrombectomy alone (E). Retrospective cohort study conducted between October 2016 and June 2025. All patients with tandem occlusions treated with endovascular therapy were included. Data were obtained from an anonymized clinical database of the Interventional Radiology Service at a high-complexity referral center in Colombia. A total of 66 patients with tandem occlusions were identified, 21 underwent CAS and 45 were treated with EVT alone. CAS (ES) group achieved higher rates of excellent reperfusion (TICI 2c-3: 76% vs 47%, P=0.024). mRS 0-2 was more frequent with CAS (42.9% vs 17.8%, p=0.03), with significantly lower mortality (19% vs 51%, P=0.013). CAS was associated with higher odds of successful reperfusion ( OR: 3.65; 95% CI, 1.14-11.69; P= 0.029), while baseline higher NIHSS was negatively associated with functional independence (adjusted OR: 0.82; 95% CI, 0.73-0.92; P= 0.002). The crude association between carotid ES group and functional outcome was not maintained in the multivariable analysis (adjusted OR: 2.07; 95% CI, 0.58-11.62; P = 0.211) Safety analysis without increase in hemorrhagic complications. Extracranial CAS was associated with higher rates of successful reperfusion without an increased risk of hemorrhagic complications. Associations with functional outcomes observed in crude analyses were not maintained after multivariable adjustment. This provide novel real-world evidence from an Latin American cohort, supporting CAS as a safe and effective strategy.

To assess patency and characterize anatomical patterns of restenosis following percutaneous transluminal angioplasty (PTA) of cephalic arch stenosis (CAS) from patients with hemodialysis arteriovenous fistulas who were enrolled in the ArterioVeNous Stent Graft in the TreatmEnt of Venous OutfloW Stenosis in Arteriovenous Fistula Access Circuits (AVeNEW) trial. Among 280 patients enrolled in AVeNEW, patients with CAS randomized to PTA were identified. Clinical data and fistulograms were reviewed through 730 days. Kaplan-Meier curves were used to estimate target lesion primary patency (TLPP) and access circuit primary patency (ACPP). The cephalic vein arch was segmented into 3 regions: proximal, arch, and terminus. Recurrence patterns were characterized by comparing the site of index stenosis with the site of restenosis using Sankey diagrams. Seventy patients with CAS were treated with PTA. Two ruptures and 2 unsuccessful PTAs yielded a modified intention-to-treat group of 66 patients. TLPP and ACPP were equivalent at the 180-, 365-, and 730-day time points: 39.5%, 13.2%, and 5.6%, respectively. Regarding post-PTA restenosis, 15 patients were censored, leaving 51 patients for analysis. Terminus stenoses recurred at the terminus. Arch region stenoses often recurred in the arch region; however, 6 (20%) of 30 formed a new terminus stenosis. PTA has a high technical successful rate for treating CAS; however, TLPP and ACPP were poor; their equivalence indicates CAS drives circuit failure. Recurrence at the index site of stenosis was the most common, although PTA of stenosis in the arch region induced a new site of stenosis at the terminus region in some patients. Proximal stenoses exhibited variable recurrence patterns.

To evaluate the safety and rates of bridging or downstaging following segmental transarterial radioembolization (TARE) in hepatocellular carcinoma (HCC) patients with baseline hyperbilirubinemia (total bilirubin [TBili] &#x2265;2.0 mg/dL). This single-institution retrospective study included 119 HCC patients (median age: 64 years, IQR: 58-71) with baseline hyperbilirubinemia who underwent 129 segmental TARE procedures between 2006 and 2021. Baseline and post-treatment liver function, toxicities, overall survival (OS), and bridging/downstaging rates were analyzed. Patients were stratified by treatment intent: palliative, bridging, or downstaging. The median absorbed dose was 211 Gy (IQR: 157-318), treatment volume 160 cc (IQR: 109-227), whole liver volume 1402 cc (IQR: 1136-1830), and percentage of liver treated 11.0% (IQR: 8.2-15.5). Median baseline TBili was 2.7 mg/dL (IQR: 2.3-3.2). Grade 3/4 bilirubin toxicity occurred in 1.0% at 1 and 3 months, and 8.0% at 6 months. Although TBili (P=0.011) and albumin (P=0.047) changed significantly over time, post-hoc testing showed no differences between timepoints, and ALBI grade remained stable (P=0.900). Median intention-to-treat OS was not reached (95% CI: 59.0 months-not calculable [NC]). The palliative group had a median OS of 22.0 months (95% CI: 18.0-NC), while OS was not reached in the bridging group. Among 71 bridging patients, 92.0% remained within Milan criteria and 78.0% underwent transplantation. Of 6 downstaging patients, 67.0% were successfully downstaged, and 2 underwent transplantation. Segmental TARE is safe and well tolerated in HCC patients with baseline hyperbilirubinemia, achieving high rates of successful bridging and downstaging to liver transplant with manageable toxicity.

To evaluate scoring balloon angioplasty of proximal carotid tandem lesions (rather than immediate carotid stent placement) after endovascular thrombectomy of intracranial large-vessel occlusion. Between January 2021 and August 2023, all patients (33 patients; mean age 72.8 years; 88% male) in a single center who presented with tandem carotid lesions after endovascular thrombectomy and were treated using a scoring balloon for angioplasty of the proximal lesion were reviewed. From a total of 376 EVT patients, 33 had tandem lesions and underwent parent artery scoring balloon angioplasty. After angioplasty, 6 patients required immediate carotid artery stent placement, 4 due to underlying dissections and 2 due to balloon failures; no procedural complications were reported. Among the 30 patients with follow-up imaging, 77% had patent arteries on follow-up imaging, 10% had complete reocclusion, and 13% had partial restenosis, although only 2 patients clinically deteriorated. At 90 days, 70% of the patients had favorable outcomes (modified Rankin Scale score of &#x2264;3), with better results observed in those who did not require immediate carotid artery stenting, and no cases of symptomatic intracranial hemorrhage occurred. Scoring balloon angioplasty is a simple, safe, and effective technical modification that may improve the safety of treatment for tandem lesions by decreasing the need for upfront carotid stent placement and anti-platelet therapy thereby possibly reducing the risk of symptomatic intracranial hemorrhage.

To assess the efficacy and safety of transarterial radioembolization (TARE) following inferior phrenic artery (IPA) glue embolization for flow redistribution in hepatocellular carcinoma (HCC). This study included 37 consecutive patients with HCC who underwent TARE following IPA glue embolization for flow redistribution between November 2021 and January 2026. Tumor response, local tumor progression-free survival (LTPFS), progression-free survival (PFS), overall survival (OS), and adverse events were retrospectively analyzed. The best response of the index tumor was complete response in 15 patients (40.5%), partial response in 18 (48.6%), and stable disease in 4 (10.8%), resulting in an objective response rate of 89.2%. The median LTPFS, PFS, and OS were 31.7, 12.5, and 31.7 months, respectively. The 12-, 24-, and 36-month LTPFS rates were 77.4%, 51.6%, and 25.8%; PFS rates were 52.0%, 29.3%, and 19.6%; and OS rates were 71.9%, 68.3%, and 48.8%, respectively. Furthermore, severe adverse events included cholecystitis (n = 2, 5.4%), prolonged prothrombin time (n = 1, 2.7%), acute kidney injury (n = 1, 2.7%), infection (n = 1, 2.7%), and radiation pneumonitis (n = 1, 2.7%). All severe adverse events were reversible with appropriate treatment, including steroid therapy for radiation pneumonitis. However, one additional patient experienced a fatal treatment-related death due to a procedure-related complication, specifically radiation pneumonitis. TARE following IPA glue embolization for flow redistribution in HCC appears to be an effective treatment and is generally well-tolerated. However, meticulous lung dosimetry is critical to ensure patient safety and minimize the risk of severe complications.

Intravascular ultrasound (IVUS) during venography in patients with chronic venous disease potentially improves identification of significant central venous stenoses. We hypothesized that IVUS use increases the rate of ulcer healing through identification and treatment of venous stenoses not visualized on venography alone. A retrospective review was performed of 170 patients (104 males, 66 females; mean age 64 years) with Clinical, Etiology, Anatomy and Pathophysiology (CEAP) 6 disease undergoing venography and intervention for active venous ulcers in 178 limbs at a single tertiary care center from 2010-2024. Patient demographics, ulcer characteristics, interventions performed and outcomes were reviewed. Procedures with venography and with (n=83 limbs, 47%) or without IVUS (n=95 limbs, 53%) were compared. Analysis assessed baseline characteristics and procedural outcomes, including ulcer healing rates, symptom scores, and healthcare utilization. Patients who underwent IVUS assessment had a higher rate of complete ulcer healing (27% vs 13%, odds ratio 2.8, p = 0.02) and larger decrease in ulcer size (p< 0.001). There was no significant difference in Venous Clinical Severity Score (VCSS) (p = 0.08). Lower healthcare utilization was observed in the IVUS group (13 wound care visits and 24 home health visits per patient-year, versus 14 wound care visits and 38 home health visits per patient-year), although this did not reach statistical significance (p = 0.06). In this retrospective cohort study, patients with active venous ulcers who underwent IVUS and venography experienced improved ulcer healing in comparison to those who underwent venography alone.

To evaluate the clinical and technical effectiveness, treatment efficiency, and safety of US-guided polidocanol sclerotherapy combined with transabdominal microwave ablation (MWA) for fibroids. 57 patients with 74 fibroids who underwent sclerotherapy combined with MWA treatment were included. Intraoperative contrast-enhanced ultrasound (CEUS) was used to assess sclerotherapy-induced vascular occlusion. Fibroid characteristics and ablation parameters were compared based on the vascular occlusion degrees (Grades 0 - 3). The non-perfusion volume ratio (NPVr) was calculated from MRI. Follow-up at 3, 6, and 12 months evaluated symptom relief, uterine/fibroid volume, hemoglobin (Hb) level, pictorial blood-loss assessment chart (PBAC) score, symptomatic severity scale (SSS), and health-related quality of life (HRQOL) scores. Adverse events were recorded. The mean patient age was 42 years (interquartile range [IQR]: 38 - 46). Complete, significant, slight, and failed occlusion rates were 48.6%, 39.2%, 6.8%, and 5.4%, respectively. The degree of occlusion was associated with fibroid classification, T2 signal intensity, and NPVr. Median NPVr was 98.5% (IQR: 88.3 - 101.1), and median ablation efficiency was 4.9 s/cm (IQR: 3.3 - 6.4). At 12 months, the complete relief rates of menorrhagia, prolonged menses, anemia, frequent micturition, and pelvic discomfort were 76.9%, 66.7%, 71.4%, 61.9%, and 68.8%. Uterine and fibroid volume decreased significantly, with improvement in Hb levels, PBAC, SSS, and HRQOL scores. No moderate-or-worse adverse events occurred. US-guided sclerotherapy followed by MWA appears to be a practical, efficient, and safe treatment for fibroids.

To retrospectively compare the safety and feasibility of early and delayed feeding protocols after uncomplicated percutaneous fluoroscopic gastrostomy placement. This retrospective, single-center study included 196 inpatients who underwent percutaneous image-guided balloon-retained gastrostomy tube placement between June 2020 and July 2024. The early feeding group (n = 96) received enteral nutrition within 4.3 hours (SD &#xb1; 2.3) following the procedure, whereas the delayed feeding group (n = 100) initiated feeding at 28.6 hours (SD &#xb1; 18.2). Data were collected on patient demographics, adverse events (AEs), time of feeding initiation, and time to discharge. There was no statistically significant difference in AE rates between the early and delayed feeding groups (0% vs 2%, P = .498). No patients in the early feeding group exhibited signs of peritonitis, tube dislodgement, or hemorrhage. In the delayed feeding group, 1 patient experienced postprocedural hemorrhage requiring embolization, and another developed postprocedural atrial fibrillation with rapid ventricular response requiring transfer to the intensive care unit. The mean times from gastrostomy tube placement to discharge were 10.0 days (SD &#xb1; 13.6) in the early feeding group and 10.8 days (SD &#xb1; 12.0) in the standard group (P = .413). Early feeding following uncomplicated, balloon-retained percutaneous image-guided gastrostomy tube placement is safe and effective, with no increased risk of AEs compared with delayed feeding. In addition, early feeding decreases fasting time, which may mitigate cumulative nutrition deficit.

To evaluate the safety, effectiveness, and prognostic factors of large-bore mechanical thrombectomy (LBMT) for acute pulmonary embolism (PE) in an all-comer population of high- and intermediate-risk patients at a tertiary center. This retrospective study analyzed 52 consecutive patients (male, 63.5% [33/52]; mean age, 62.6 years [SD &#xb1; 17.3]) undergoing LBMT for acute PE from 2019 to 2024: 57.7% (30/52) high-risk and 42.3% (22/52) intermediate-risk per European Society of Cardiology (ESC) criteria with a Pulmonary Embolism Severity Index (PESI) score of 160.7 (SD &#xb1; 51.7). Patients excluded from clinical trials-with malignancy (57.7% [30/52]), metastatic disease (13.5% [7/52]), and nonimprovement despite systemic thrombolytics (19.2% [10/52])-were included. Procedural outcomes, adverse events (AEs), and mortality predictors were examined. Median follow-up was 13.7 months (interquartile range, 5.4-22.3 months). Mean pulmonary artery pressure decreased by 6.9 mm Hg (SD &#xb1; 6.4). Refined modified Miller index reduced by 13.7 (SD &#xb1; 5.9). Survival was 66.7% (20/30) for high-risk patients and 95.5% (21/22) for intermediate-risk patients at 6 months (P = .01). Society of Interventional Radiology (SIR) severe AEs occurred in 5.8% (3/52) of patients. Independent 6-month mortality predictors were metastatic disease (odds ratio [OR], 42.5; 95% CI, 3.28-258.81; P < .001), PESI score (OR, 1.03 per point; 95% CI, 1.00-1.06; P = .04), and ESC stratification (OR, 0.08; 95% CI, 0.003-0.48; P = .03). In an unselected tertiary setting, LBMT demonstrates safety and effectiveness for acute PE with excellent survival of intermediate-risk patients and clinically meaningful outcomes for high-risk populations generally excluded from trials.

To identify components of the Symptoms-Varices-Pathophysiology (SVP) classification predictive of clinical recurrence after embolization of the 4 major pelvic venous axes in patients with pelvic venous disorders (PeVDs). This prospective multicenter cohort study included women with PeVD treated at 6 hospitals using a unified diagnostic, embolization, and follow-up protocol. Clinical, anatomical, and hemodynamic variables were classified according to the SVP system. Recurrence was defined as clinical worsening with a &#x2265;1-category increase in visual analog scale score, associated with duplex ultrasound (US) evidence of directed reflux and venographic confirmation of an active escape pathway. Statistical analysis included chi-square testing, logistic regression, relative risk (RR) estimation, and Kaplan-Meier analysis. Among 244 patients, 117 (48.0%) developed clinical recurrence during 24 months of follow-up. Nonsaphenous lower-extremity varices (V3b) were present in 75.8% of the cohort and were strongly associated with recurrence. Patients with V3b varices had higher re-embolization rates (52.4% vs 34.5%; RR, 1.52; P = .016). In multivariate analysis, V3b was the only independent predictor of recurrence (odds ratio, 16.16; 95% CI, 5.23-49.92; P < .001). Recurrence occurred earlier and more frequently in patients with V3b varices, with reduced recurrence-free survival on Kaplan-Meier analysis (hazard ratio, 2.56; P < .001). V3b varices are the strongest independent predictor of clinical recurrence after embolization for PeVD, representing a compensated hemodynamic phenotype with persistent extrapelvic decompression. Identification and targeted treatment of these escape pathways should be incorporated into diagnostic and therapeutic strategies.

To evaluate the association between genetic mutations and clinical outcomes, including response and time to progression, in patients with breast cancer liver metastasis treated with Y-90 radioembolization. This is a retrospective, single-institution study. 110 female patients with breast cancer liver metastasis who underwent Y-90 radioembolization were included. Genomic profiling was conducted using MSK-IMPACT. Patient demographics and treatment response were collected from electronic medical records and Picture Archiving and Communication System (PACS). Y-90 response was categorized as complete, partial, none, or progression. Time to progression was analyzed in patients with an initial response. Median survival using Kaplan Meier estimation was correlated to genetic mutations. 17 patients died before progression was assessed, and 6 patients were not yet evaluated post-procedure. Overall median survival was 32.8 months (1.3 - 173.0). Patients with the ERBB2 mutation showed the longest median survival (70.2 months [12.5 - 173.0]), while the RAD21 mutation had the shortest median survival (25.5 months [2.4 - 173.0]). KDM5C and CBFB mutations were associated with the highest response rates (100%, p=0.003 and p=0.014, respectively), while the H3C13 mutation was associated with the lowest response rate (0%, p=0.002). Median time to progression was 32.8 months (1.4 - 173.0) in patients with an initial treatment response. The H3F3B mutation was associated with the longest time to progression (105 months [50.2 - 105.0]), while the RUNX1 mutation was associated with the shortest time to progression (1.4 months [1.4 - 36.5]). Specific genetic mutations are associated with survival, response rate, and time to progression after Y-90 radioembolization. This study underscores the potential use of genetic profiling to individualize treatment plans.

Occupational radiation exposure has a clear association with long-term health effects and has a particular impact on women, trainees, and supporting staff. There is a reliance on limited, traditional radiation protection and nonergonomic equipment, which carries associated orthopedic injury rates with adverse impacts on both individual career trajectories and health systems, and with significant challenges to widespread implementation of enhanced radiation protection devices. During the 2025 Society for Cardiovascular Angiography & Interventions Scientific Sessions in Washington, DC, a multidisciplinary Think Tank summit was convened and included representatives from multiple stakeholders, including other professional societies, advocacy groups, and industry partners. The focus of discussion was on the dual dangers of both ionizing radiation and the musculoskeletal injuries associated with current-generation protection equipment. This document summarizes the main points of discussion and outlines actionable next steps to advocate for more widespread implementation of enhanced radiation protection technologies and imaging systems in order to achieve ALARA+ (as low and as light as reasonably achievable).

To evaluate the feasibility, safety, and early outcomes of percutaneous image-guided screw fixation (PIGSF) for radiation-induced pelvic insufficiency fractures (R-PIFs). This study retrospectively analyzed consecutive patients with symptomatic R-PIFs treated by PIGSF under computed tomography (CT) or cone-beam CT guidance between January 2021 and January 2024 in 3 tertiary centers. Screws were positioned via transsacroiliac approaches, with cement injected into the fracture site and screw trajectory. Clinical evaluation included pain, analgesic use, mobility, and patient-reported quality of life (QoL). Follow-up included standardized consultation and CT at 1 month. Eighteen patients (mean age, 71.0 years [SD &#xb1; 6.5]; women, 61%) were included. Technical success was achieved in all interventions, with a median procedure duration of 63 minutes (range, 45-90 minutes). A total of 32 screws were implanted (mean, 1.8 per procedure). No intraoperative or early adverse events occurred. All patients were able to stand up and walk within 24 hours, and 17 of 18 were discharged on Day 1. At 1 month, maximal pain intensity decreased from 8.6 (SD &#xb1; 1.8) to 3.3 (SD &#xb1; 2.8) (P < .0001), and mean pain intensity decreased from 7.2 (SD &#xb1; 2.0) to 2.0 (SD &#xb1; 1.8) (P < .0001). QoL improved from 40.0 (SD &#xb1; 22.4) to 72.3 (SD &#xb1; 22.4) (P = .0036). PIGSF for R-PIFs is technically feasible, safe, and associated with rapid pain relief, early mobilization, and improved QoL.

This study evaluates the efficacy and safety of the GORE VIABAHN VBX Balloon Expandable Endoprosthesis in treating post-transplant portal vein stenosis (PVS). Nine patients (mean age 49 &#xb1; 9.2 years) with post-transplant PVS were treated with a single VBX stent between March 2018 and May 2024 in this retrospective, single-center review. Access was via transhepatic (n=2), transsplenic (n=6), or combined (n=1) approaches. Technical success and patency were assessed retrospectively. Technical success was achieved in all cases, with improved hepatopetal flow. Eight cases of primary patency (89%) and one of primary assisted patency (11%) were established over a mean follow-up of 41 &#xb1; 9.2 months. No SIR adverse events were associated with stent placement. The VBX stent graft demonstrated high technical success, sustained patency, and safety in treating post-transplant PVS. This study presents the VBX stent as a potential treatment option for PVS in post-liver transplant patients.