BackgroundParastomal varices are a rare but serious complication in patients with portal hypertension, characterised by bleeding that can be life-threatening in a predominantly comorbid population. Traditional surgical approaches to managing parastomal varices are associated with high morbidity and recurrence rates, prompting increased interest in minimally invasive techniques. This systematic review aims to evaluate the efficacy and safety of interventional radiology (IR) procedures, including transjugular intrahepatic portosystemic shunt (TIPS), sclerotherapy and embolisation, in managing parastomal varices.MethodsA comprehensive literature search was conducted across multiple databases, including MEDLINE, EMBASE and Web of Science, to identify studies published up to January 2025 that reported IR interventions for parastomal varices. Data were extracted on patient demographics, procedural success, recurrence rates and complications. A pooled proportions meta-analysis was performed.ResultsFive studies, encompassing 45 patients, met the inclusion criteria. The pooled technical success rate of IR procedures was 91.3%, with a clinical success rate of 80.5% over a mean follow-up of 618.4 days. The pooled mean proportion of rebleeding, predominantly minor and non-life-threatening, was 36.4%. TIPS showed the highest efficacy, but is traditionally associated with increased procedural risks compared to other interventional radiology methods.ConclusionIR offers a highly effective and safe alternative to traditional surgical management for parastomal varices in contemporary terms. The low recurrence and complication rates highlight the potential of IR ab initio as a first-line treatment; consequently, we advocate for its use, particularly in patients unsuitable for surgery in the minimally invasive era.Systematic review registrationPROSPERO CRD42024627470.

BackgroundTumor visualization during computed tomography (CT)-guided radiofrequency ablation (RFA) of adrenal adenomas is often limited by the small size of the lesion and needle-induced artifacts. These limitations can impair accurate needle placement and increase the risk of incomplete ablation. This report shows four adrenal RFA procedures in which iodized oil (Lipiodol®) marking enhanced lesion visibility.Case presentationCT imaging and adrenal venous sampling showed unilateral right aldosterone-producing adenomas measuring 10–20 mm in patients with primary aldosteronism. Contrast enhancement of the nodules was confirmed via CT angiography after microcatheter insertion into the adrenal artery. Transarterial embolization was performed utilizing a 1:1 mixture of Lipiodol and iohexol. In three cases, Lipiodol deposition within the adenomas was confirmed on CT immediately post-embolization and persisted on the following day. Despite needle-induced artifacts during RFA, nodule visibility significantly improved. RFA was completed without major complications, which resulted in the resolution of primary aldosteronism and hypertension. In one case, although Lipiodol marking was discontinued due to the extravasation from the adrenal artery branch, RFA was completed on the following day.ConclusionsCT-guided RFA with Lipiodol marking facilitated the effective treatment of aldosterone-producing adrenal adenomas in three patients by significantly enhancing lesion visibility. Adrenal arterial embolization should be addressed with caution to avoid damaging the small blood vessels of the adrenal gland.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1186/s42155-025-00614-2.

Determining the safety of Optical Coherence Tomography (OCT) and Fractional Flow Reserve (FFR) in Percutaneous Transluminal Angioplasty (PTA) for below-the-knee vascular disease. In this prospective single-center non-randomized trial, patients who underwent PTA for below-the-knee vascular disease with lesions no longer than 3cm were included. Based on digital subtraction angiography (DSA) using iodine contrast agent, the physician was asked to estimate the diameter of the target vessel and degree of stenosis of the target lesion. The investigated tools are OCT, which is an intravascular imaging technique using near-infrared light and iodine contrast agent to visualize the vessel wall, and FFR, which measures the pressure gradient along a stenosis in a hyperemic state. The primary outcomes were the safety and feasibility of performing these measurements. OCT and FFR measurements were conducted before and after PTA. Physicians were not allowed to interpret study measurements during the procedure, as the safety and feasibility of these novel techniques have not yet been proven. To assess the secondary outcomes, physicians interpreted the measurements after the procedure to determine whether OCT or FFR would have changed intra-operative decision-making such as not performing PTA, the use of other balloons or stents, and additional revascularization based on the OCT and FFR measurements. Ten patients were included. The target lesion was significant in nine patients based on angiography, who were therefore treated. Seven patients were treated with PTA using plain-old-balloon and two patients were treated using atherectomy devices. No complications occurred during or after the procedures and measurements were successfully conducted in all patients. Overall, OCT and FFR would have led to a change in intra-operative decision-making in 7 patients. Estimation of the diameter of the target vessel varied from the value measured with OCT with more than 0.5mm in 4 cases. FFR measurements demonstrated target lesions to be hemodynamically insignificant in 6 cases, while it showed target lesions to remain hemodynamically significant despite treatment in 3 cases. OCT and FFR are feasible to use in below-the-knee PTA and may cause significant alterations in perioperative decision-making by providing previously unavailable information on lesion size and morphology and hemodynamic significance.

PurposeThe aim of this systematic review and meta-analysis was to identify the technical and clinical outcomes of stent-graft implantation in patients with hepatic artery bleeding.Materials and methodsThe PubMed database was searched for publications between 2000 and March 2025 evaluating patients treated with stent-graft implantation for hepatic arterial hemorrhage. The outcome measurements were technical (successful hemostasis with stent-grafts) and clinical success (no rebleeding from hepatic arteries), early mortality, and stent-graft patency during follow-up. A modified Newcastle–Ottawa Scale (NOS) was used to assess the quality of the included publications. An individual patient data meta-analysis was performed using the chi-square test or Fischer exact test to identify predictors of stent-graft patency.ResultsIn total, 351 patients from 22 studies were included. The mean NOS score was 5.4 ± 0.95. Most patients (n = 323) had bleeding after surgery. The technical success rate of stent-graft placement was 94.3%. Patients with technical failure were managed either by surgery (n = 10) or coil embolization of the hepatic artery (n = 10). Rebleeding from hepatic arteries was seen in 24 patients with a clinical success rate of 92.7%. The early mortality rate was 15.6%.Follow-up showed stent-graft patency in 76.5% (202 of 264) of the cases. Most of the stent-graft occlusions (51/62, 82.2%) were asymptomatic. No significant difference was seen in the rate of stent-graft patency between patients receiving acetylsalicylic acid or not, or dual antiplatelet treatment or not. Overlapping stent-grafts (p = 0.009) were significant risk factors for stent-graft occlusion.ConclusionStent-graft implantation in hepatic arterial bleeding is associated with high technical and clinical success rates. Despite the considerable rate of stent-graft occlusion during follow-up, occlusion is mostly asymptomatic, probably due to collateral development.Supplementary InformationThe online version contains supplementary material available at 10.1186/s42155-025-00608-0.

BackgroundGenicular artery embolization (GAE) is an emerging, effective pain treatment for symptomatic knee osteoarthritis. A potential concern of this procedure is non-target embolization of cutaneous and subcutaneous vessels, which can lead to severe skin complications such as necrosis. To mitigate this risk, some operators use periarticular cooling with the rationale of inducing vasoconstriction. The vasoconstrictive effect on non-target subcutaneous vessels caused by cooling has, however, not yet been objectively demonstrated. This study aims to provide the first objective evidence for this common safety maneuver.MethodologyThis retrospective analysis is based on a cohort of 36 patients (39 knees). The study evaluated a total of 49 selective angiographies of medial or lateral genicular arteries, which were stratified based on the presence of a superficial blush. Three cohorts were defined for comparison: 1) The Cooling Cohort, comprising 20 angiographies (from 10 knees) that showed a blush and were treated with periarticular cooling. 2) The Blush-Control Cohort, consisting of 18 angiographies (from 18 knees) with a blush but without a cooling maneuver. 3) The No-Blush Control Cohort (11 knees). The blush area on DSA was quantitatively analyzed for both groups with a superficial blush; in the Cooling Cohort, the area was compared before and after the intervention, while the baseline blush was quantified for the Blush-Control Cohort. Skin-related adverse events were systematically recorded and compared at the patient level across all three cohorts.ResultsThe application of periarticular cooling resulted in a significant reduction in the mean blush area from 464.8 ± 447.6 mm2 to 240.1 ± 208.2 mm2 (p = 0.012), corresponding to an average reduction of 73.8% (p = 0.0006). Patients receiving cooling showed significantly fewer skin alterations than the blush-control group [median score 1 vs 2, p = 0.0174].ConclusionPeriarticular cooling is a simple, non-invasive, and effective technique that significantly reduces quantifiable non-target cutaneous perfusion during GAE. Our work provides objective evidence supporting its use as a standard safety-enhancing maneuver to minimize the risk of skin-related complications.

This study aimed to reveal the impact of nodular calcification (NC) on restenosis risk in patients undergoing femoropopliteal drug-coated balloon (DCB) angioplasty for symptomatic atherosclerotic peripheral artery disease. We retrospectively analyzed 568 patients who underwent endovascular therapy with DCB for de novo femoropopliteal lesions under intravascular ultrasound guidance between November 2017 and February 2021 at seven cardiovascular centers in Japan. Patients with lesions without calcification were excluded from the study. The patients were classified into two groups based on the presence or absence of NC: the NC [ +] group (n = 200) and the NC [-] group (n = 368). The main outcome was the primary patency at 3years. Cox proportional hazards analysis was used to determine whether NC was an independent predictor of clinical outcomes. The 3-year primary patency rates were significantly lower in the NC [ +] group than in the NC [-] group (53.8% vs. 65.8%, p = 0.001). After multivariate analysis, the presence of NC was independently associated with restenosis risk; the adjusted hazard ratio was 1.61 (95% confidence interval 1.15 to 2.26, p = 0.006). The NC is an independent predictor of restenosis in patients undergoing DCB angioplasty for femoropopliteal lesions. Patients with NC had a significantly lower primary patency, highlighting their negative impact on clinical outcomes. Further research is required to establish evidence-based strategies for managing calcified femoropopliteal lesions.

Endovascular therapy (EVT) is a well-established revascularization strategy for patients with peripheral artery disease. However, achieving optimal wire crossing in complex chronic total occlusion lesions remains technically challenging. Intravascular ultrasound (IVUS)-guided wiring facilitates safer and more effective procedures. However, aligning IVUS findings with fluoroscopic imaging is challenging due to catheter rotation. We report a novel technique-termed the IDEAL technique-that leverages the deep vein as an anatomical landmark to correct IVUS rotational orientation. A 76-year-old female presented with chronic limb-threatening ischemia in the right toe. Contrast-enhanced computed tomography revealed a chronic total occlusion in the right superficial femoral artery. EVT was performed via the right common femoral artery. IVUS revealed that the first guidewire had entered the subintimal space partway through its course. Using preprocedural computed tomography, the deep vein was identified and its clock-face position relative to the artery was determined. This anatomical landmark enabled correction of IVUS image rotation, allowing accurate re-direction of a second guidewire under fluoroscopic guidance, thereby successfully crossing into the intraplaque lumen. The IDEAL technique quickly provides anatomical orientation by utilizing the deep vein as a landmark during IVUS-guided wiring-making it, quite literally, ideal.

BackgroundEndovascular stenting is widely accepted as the standard treatment for central venous obstruction syndromes such as superior vena cava (SVC) syndrome due to its demonstrated clinical efficacy and improved patient outcomes. However, its application in axillosubclavian vein thrombosis (ASVT) has been limited due to concerns about stent compression within the thoracic outlet. This report aims to evaluate the feasibility and safety of the off-label use of dedicated venous stents—engineered with enhanced mechanical features—as an alternative endovascular approach for the treatment of ASVT.MethodsThirty-eight patients (43 affected limbs) with symptomatic ASVT and no prior treatment or surgical decompression underwent endovascular placement of dedicated venous stents across the thoracic outlet with Abre Venous Stents (Medtronic, Dublin, Ireland), Venovo Venous Stents (BD, Franklin Lakes, NJ, USA), or Vici Venous Stents (Boston Scientific, Marlborough, MA, USA). Stents were extended peripherally to the subclavian or axillary veins and centrally to the brachiocephalic vein or SVC. Technical success was defined as successful stent deployment across the costoclavicular space, and clinical success as symptomatic improvement.ResultsStent placement was technically successful in all 43 limbs (100%), with clinical improvement observed in 97.4% of patients. The one patient without clinical improvement experienced early thrombosis of the stent, requiring mechanical thrombectomy and additional stenting. Follow-up CT venography at a mean of 301.3 days demonstrated high primary stent patency rates (81.4%), with stent crushing observed in only 7.0% of limbs and no instances of stent fracture. Adverse events were limited, including two access site hematomas and one hypotensive episode, all of which resolved without evidence of long-term complications.ConclusionsOur findings suggest that stenting across the thoracic outlet for the treatment of ASVT may be a viable option with the use of novel dedicated venous stents, potentially expanding treatment strategies for TCVO.

BackgroundThoracic endovascular aortic repair (TEVAR) has been a feasible treatment option since the first stent graft was approved by the FDA in 2005, and is now the recommended method for treating most descending aorta pathology in the current clinical practice guidelines. Indications for TEVAR include descending aorta aneurysms, traumatic aortic injury and pathology that presents as acute aortic syndrome. More often than not the lesion that needs to be excluded is quite close or contains the distal aortic arch, thus requiring the coverage of the left subclavian artery (LSA) origin, a practice that has been associated with severe complications. Contraindications to LSA coverage resulted in the development of various surgical and endovascular LSA revascularization techniques.Materials and methodsBranched stent grafts containing a single branch for the LSA are a rapidly evolving technology regarding LSA reconstruction during TEVAR. The aim of this article is to demonstrate our center’s experience using a novel off-the-shelf single-branched stent graft, the GORE® TAG® Thoracic Branch Endoprosthesis (TBE) (W. L. Gore & Associates, Inc, Flagstaff, Ariz, USA). The GORE® TAG® TBE is commercially available in Europe since early 2024. We have so far, since February 2024, treated 12 patients using this endograft, successfully treating all types of aortic lesions.ConclusionsBranched TEVAR is becoming a feasible option for treating descending aorta pathology, without covering the LSA. Moreover, the development of off-the-shelf branched stent grafts, enables physicians to treat patients in the emergency setting, aside from planned procedures.