Transcatheter arterial chemoembolization (TACE) is a proven and widely accepted treatment option for hepatocellular carcinoma and it is recommended as first-line non-curative therapy for BCLC B/intermediate HCC (preserved liver function, multifocal, no cancer-related symptoms) in patients without vascular involvement. Different types of TACE are available nowadays, including TAE, c-TACE, DEB-TACE, and DSM-TACE, but at present there is insufficient evidence to recommend one TACE technique over another and the choice is left to the operator. This review then aims to provide a comprehensive overview of the current literature on indications, types of procedures, safety, and efficacy of different TACE treatments.

Background: Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. Percutaneous thermal ablation is an effective treatment, but standard ultrasound (US) guidance is limited in cases of inconspicuous nodules. Ultrasound fusion imaging (USFI), which overlays cross-sectional imaging onto real-time US is an emerging technique that improves tumor visibility and technical feasibility. This study reports real-life outcomes of USFI-guided microwave ablation (MWA) for HCC in two Italian centers. Materials and Methods: In this multicentric retrospective study, 56 patients with 73 poorly or non-visible HCC nodules underwent USFI-guided percutaneous MWA with no visibility or poor visibility on B-mode US. Technical success, complications, and local tumor control were evaluated, with follow-up imaging at 1 month and every 3 months thereafter. Results: Complete response (CR) at 1 month was observed in 78.1% of nodules, with residual disease (RD) more common in poorly visible nodules than non-visible nodules (18.1% vs. 4.2%, p = 0.019). During a median 13-month follow-up, local tumor progression (LTP) occurred in 9.6% of patients. No significant association was found with difficult tumor location. Conclusions: USFI-guided MWA is a safe and effective option for treating HCC nodules not adequately visualized with conventional US, expanding eligibility to complex cases.

Iliac artery aneurysms (IAA) associated with abdominal aortic aneurysms (AAA) are found in 10%–20% of AAAs. Isolated internal iliac artery aneurysms (IIAAs) are an uncommon entity, representing 0.3%–0.5% of all intra-abdominal aneurysms, incidentally discovered or late diagnosed with frank rupture. Despite the high mortality, shared and standardized guidelines on treatment management of IIAAs are currently lacking. We report the case of an 82-year-old male diagnosed and managed in our institution for a left internal iliac artery aneurysm excluded after aorto-bisiliac prosthesis surgery. After an initial endovascular attempt, the procedure was converted to a direct transabdominal puncture approach. Post-procedural evaluation demonstrated a clinical success without evidence of aneurismal sac filling and stable aneurysmal sac volume. The viability of transabdominal sac puncture, especially in cases with complex anatomy or when traditional access methods are inadequate, represents a promising alternative, particularly in poor candidates to conventional iliac surgery.

Background/Objectives: the aim of this study was to evaluate the safety and efficacy of percutaneous transhepatic lithotripsy using the SpyGlassDSTM cholangioscopy system for the treatment of difficult stones. Methods: Retrospectively, all patients treated with percutaneous transhepatic lithotripsy using SpyGlassDSTM cholangioscopy system were analyzed. As primary outcome measures, the following data were assessed: the presence of a previous history of the hepatobiliary disease, location of stones, reasons for the choice of the procedure, previous balloon bilioplasty, type of pre-procedural imaging, procedural time, technical success, clinical success, and post-procedural complications (according to CIRSE classification). Clinical success was considered “primary” when achieved with a single treatment, and “secondary” if more than one treatment was required in the duration of follow-up. Results: 10 patients (6 males and 4 females, mean age = 64 years, SD = 22), all with cholangitis due to gallstones, underwent 11 PTL procedures using SpyGlassDSTM. Technical and clinical successes were achieved in all patients (100%). Primary success was observed in 4/10 (40%) patients, while the remaining 6/10 (60%) patients undergoing re-treatment, and all showed secondary success (100%). No periprocedural complications were observed. In 10/11 procedures (90%), no relevant adverse events were recorded within the first thirty days of follow-up. In 1/11 case (9%), mild complications (grade I according to CIRSE classification) were registered in the following days after the procedure (<30 days). Conclusions: in conclusion, the treatment of percutaneous transhepatic lithotripsy using SpyGlassDSTM cholangioscopy of difficult stones has been demonstrated as efficient and safe treatment.