JVIR EDITORS’ RESEARCH HIGHLIGHTS

Randomized Controlled Trial Comparing Radiologic Pigtail-Retained Gastrostomy and Radiologic Mushroom-Retained Gastrostomy” Kichang Han et al. Volume 28, Issue 12 (December 2017)

• Prospective randomized controlled trial compared 14-F pigtail-retained gastrostomy (PG; 50 patients) and 20-F mushroom-retained gastrostomy (MG; 49 patients) (level of evidence 1b).
• Technical success rate was 100% for both groups.
• Minor complication rate was higher in the PG group (34%) than in the MG group (12.2%; P = .016) owing to higher rates of tube occlusion (16% vs 0%) or dislodgment (4% vs 0%) and peristomal leakage (6% vs 2%).
• Major complication rate was 2% in the PG group and 0% in the MG group (P > .05).

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A Comparison of Concomitant Tributary Laser Ablation and Foam Sclerotherapy in Patients Undergoing Truncal Endovenous Laser Ablation for Lower Lime Varicose Veins 

Summary

A prospective non randomized controlled study comparing the efficacy and safety of simultaneous tributary vein ablation with either Foam Sclerotherapy (FS) or Endovenous Laser ablation(EVLA) while performing EVLA of the greater saphenous vein was conducted. 418 patients were enrolled (CEAP score between 2 and 6), 163 underwent tributary vein EVLA at 8 Watts while 255 underwent FS with 3% Polidoconol using the Tessari technique. Outcomes were measured at 3 days, 4 weeks and 6 months using the Aberdeen Varicose Vein Questionnaire(AVVQ), EuroQol Group 5(EQ-5D) and Numerical rating scale for pain. At 4 weeks and 6 months respectively, the EVLA group exhibited poorer QoL than the FS group (P<0.001 for AVVQ ;P<0.01 for EQ-5D) and (P<0.5 for AVVQ; P<0.05 for EQ-5D). At 6 months the FS group had lower (4.9%) visible varicosities than the EVLA group (21.6%). FS group reported significantly higher post procedural pain only at 4 weeks (P<0.001. Persistent ecchymosis, pigmentation and local induration were significantly higher in the FS group at both 4 weeks and 6 months (9.3%vs 6.2%). The authors concluded that concomitant tributary ablation with FS during truncal laser ablation of the GSV is more efficacious and improves Qol compared to EVLA.

Commentary

This paper evaluates the utility of concomitant treatment of tributary veins using 2 different techniques. Advantage of simultaneously treating tributary varicosities include lesser cost and reduced need for a second procedure. Simultaneous treatment is associate with longer procedure time and post-procedure discomfort. Supported by recent randomized studies favoring simultaneous treatment, the National Institute for Health and Care Excellence has set simultaneous tributary vein treatment as the standard of care. Phlebectomy is more invasive than EVLA and FS. Based on the paper, the treatment of choice for tributary veins appears to be FS.

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Wang JC, Li Y, Li GY, et al. A Comparison of Concomitant Tributary Laser Ablation and Foam Sclerotherapy in Patients Undergoing Truncal Endovenous Laser Ablation for Lower Limb Varicose Veins. J Vasc Interv Radiol 2018; 29:781-9.

Post Author:
Anil K Pillai, MD
Associate Professor and Section Chief,
University of Texas Health Science Center, Houston, TX 77030
Anil Pillai@AnkupiMD

Vaccum-Assisted Thrombectomy in AVF and AVG

Summary

This prospective study included 35 patients with acutely thrombosed AVF and AVG that underwent Thrombectomy using the Indigo device. The study sought out to evaluate if the Indigo system would be safe, effective, decrease procedure time and complications. No patient was excluded during the study period. The authors used systemic heparin (no TPA), obtained antegrade and retrograde access to treat the thrombus, with adjunctive use of angioplasty and or stents for stenosis, occlusion balloon for thrombus in the arterial anastomosis and Trerotola device for adherent thrombus in an aneurysmal segment. The authors evaluated technical and clinical success, primary patency, primary assisted patency, and secondary patency, procedure time, blood loss and complications. Technical success was 34 out of 35 patients, with clinical success in 32 out of 35 patients. Three complications were not attributed to the device. As expected 93% of patients required angioplasty, 2 patients stent grafts, 1 patient required Trerotola device and 2 patients occlusion balloon. Average procedure time was 38 minutes, average blood loss was 122 mL, 6 month primary patency, primary assisted patency and secondary patency was 71%, 80% and 88.5%. The results of this study demonstrate high technical and clinical success, comparable or better to other studies published. Average procedure time (38 minutes) was also improved when compared to Angiojet (78 minutes), mechanical thrombolysis (126 minutes). Similarly patency rates compare favorably compared to other systems such as Angiojet, Trerotola, etc. Changes in hemoglobin were not seen in 17 patients that had hemoglobin levels checked after the procedure. The biggest limitation is the small number of patients, lack of cost analysis and lack of control group for comparison. The authors conclude that the indigo system is safe and effective with promising patency rates and procedural times when compared to other systems or techniques.

Figure- Representative fistulogram demonstrates the initial injection with thrombus in the graft (A), fistulagram after antegrade thrombectomy but before angioplasty of the stenotic lesion (B), fistulagram after thrombectomy and angioplasty of the lesion (C), fistulagram from the brachial artery showing thrombus in the arterial end (D), and final fistulagram after retrograde thrombectomy.

Commentary

This study provides promising data regarding the use of the Indigo system for the treatment of thrombosed dialysis access. With low procedural times, high patency rates at 6 months and low complications rates, this system has the potential to replace other systems. The authors required the use of adjunctive systems in 3 separate cases, and as expected angioplasty was required in the majority of the cases to threat the underlying lesions. The biggest limitation in this study was the lack of cost analysis and lack of control group. Future studies that compare the indigo system against other systems (mechanical thrombectomy, Angiojet, Trerotola, etc) and provides a cost analysis will elucidate if the Indigo system can become a first line system in the treatment of thrombosed dialysis access.

Click here for abstract

Marcelin C, D'Souza S, Le Bras Y, Petitpierre F, Grenier N, van den Berg JC, Huasen B. Mechanical Thrombectomy in Acute Thrombosis of Dialysis Arteriovenous Fistulae and Grafts Using a Vacuum-Assisted Thrombectomy Catheter: A Multicenter Study. J Vasc Interv Radiol. 2018 Jul;29(7):993-997.

Post Author: 
Carlos J. Guevara, MD
Assistant Professor
Department of Radiology, Interventional Radiology Division
University of Texas Health Sciences, Houston
@UTHouston_IR