Woo Jin Yang, Danbee Kang, Myung Gyu Song, Tae-Seok Seo, and Ji Hoon Kim. Gut and Liver 2022;16:976-84. https://doi.org/10.5009/gnl210567

PURPOSE This study aimed to evaluate the technical success rate, complications, and radiation doses of ultrasound- and fluoroscopy-guided percutaneous nephrostomy (PCN) in patients with a nondilated renal collecting system. METHODS Over a 10-year period, 50 patients were referred for PCN of 60 kidneys with a nondilated renal collecting system. The patients included 22 males and 28 females with a mean age of 63.2 years (range: 35-87 years). The most common reason for PCN in these patients was postoperative ureteral leaks and/or fistula (21/50 patients). PCN was performed under ultrasound and fluoroscopic guidance. During PCN, intravenous contrast media or diuretics were not used. Technical success rate, complications, procedure time, and radiation exposure of the procedure were retrospectively evaluated. RESULTS Ultrasound- and fluoroscopy-guided PCN for nondilated renal collecting system showed a success rate of 83.3% (50/60 kidneys) in the initial attempt. Four PCNs were repeated and were successful after the initial PCN failure. There was 1 major complication of bleeding that required transfusion in 1.9% (1/54) PCNs and there were minor complications of transient gross hematuria through the PCN catheter in 31.5% (17/54) PCNs. Mean duration of the procedure was 15.97 +/- 7.81 min and median fluoroscopy time was 4.2 min (range: 1.2-15.3 min). Median dose area product and cumulative dose were 345.37 mu Gy center dot m(2) (range: 42.57-1659.76 mu Gy center dot m(2)) and 46.9 mGy (range: 7.7-267.8 mGy), respectively. CONCLUSION Ultrasound- and fluoroscopy-guided PCN for nondilated renal collecting system was feasible with acceptable technical success rate, complication rate, procedure time, and radiation exposure.

박혜진, et al. J Korean Soc Radiol. 2024 Jan;85(1):161-170. https://doi.org/10.3348/jksr.2023.0061

Background: The optimal antiplatelet regimen after standard endovascular aneurysm repair (EVAR) in patients without atherosclerotic cardiovascular disease remains uncertain. Clinical guidelines offer limited recommendations, and data specific to this population are sparse. This study aimed to compare the efficacy and safety of single versus dual antiplatelet therapy (DAPT) in patients undergoing standard EVAR for abdominal aortic aneurysms without established atherosclerotic cardiovascular disease. Methods: This study emulated a target trial using the Korean National Health Insurance Service database, which includes the entire Korean population. We identified all patients who underwent standard EVAR between January 2003 and September 2023 and excluded those with atherosclerotic cardiovascular disease or no antiplatelet therapy. Patients were categorized by discharge medication into single antiplatelet therapy or DAPT groups. The primary cardiovascular efficacy end point was major adverse cardiac and cerebrovascular events (all‐cause death, myocardial infarction, or ischemic stroke). The EVAR‐specific efficacy end point was abdominal aortic aneurysm reintervention or surgery. The safety end point was major or clinically relevant nonmajor bleeding. Inverse probability treatment weighting was applied to adjust baseline differences. Results: Among 8325 patients, 4162 (50.0%) received single antiplatelet therapy (80.6% aspirin, 19.4% clopidogrel), and 4163 (50.0%) received DAPT (aspirin plus clopidogrel). There were no significant differences between single antiplatelet therapy and DAPT in the risk of major adverse cardiac and cerebrovascular events (inverse probability treatment weighting‐hazard ratio [HR], 1.07 [95% CI, 0.93–1.22]) or abdominal aortic aneurysm reintervention/surgery (inverse probability treatment weighting‐HR, 1.07 [95% CI, 0.92–1.24]). However, DAPT was associated with a higher risk of major or clinically relevant nonmajor bleeding (inverse probability treatment weighting‐HR, 1.20 [95% CI, 1.02–1.41]). Conclusions: In patients without atherosclerotic cardiovascular disease undergoing standard EVAR, DAPT did not confer cardiovascular or procedural benefit but was associated with increased bleeding. Single antiplatelet therapy may represent a safer and equally effective antiplatelet strategy in this population. Registration: URL: https://clinicaltrials.gov ; Unique Identifier: NCT06876727.

Background: This study aimed to assess the safety and feasibility of a 3-month flushing interval for totally implantable venous access ports (TIVAPs), particularly regarding intraluminal clot formation. Methods: Between May 2017 and September 2018, we established a single-center cohort of 151 patients who were referred for TIVAP removal and categorized them into three flushing-interval groups: A (⩽1 month), B (1–2 months), and C (2–3 months). Odds ratios (OR) with 95% confidence intervals (CI) were computed using logistic regression to determine the risk of intraluminal clot occurrence. To compare clot lengths among the groups, we employed linear regression. Restricted cubic splines were used to model the flushing interval as a continuous variable. Results: Compared to Group A, Groups B and C had adjusted ORs of 0.82 (0.35–1.92) and 0.78 (0.29–2.11) for intraluminal clot risk. Occlusion was rare (1/151; 0.7%) and successfully treated with mechanical recanalization. Adjusted differences in clot length compared to Group A were 0.01 (−0.85 to 0.87) for Group B and −0.23 (−1.21 to 0.76) for Group C. Spline regression analysis showed no significant association between the flushing interval and clot length ( p for trend = 0.84). Conclusion: The incidence and burden of intraluminal clots did not increase significantly within the first 3 months. Occlusion was rare, even in the presence of clots, and was successfully treated. Therefore, a 3-month flushing interval appears to be a safe and practical option, aligning with the common recommendation for surveillance intervals in patients with cancer.

Background and Objectives: Transarterial embolization (TAE) serves as a valuable alternative for gastrointestinal bleeding when endoscopy fails or is inaccessible. Quick-soluble gelatin sponge particles (QS-GSPs) dissolve rapidly and may reduce ischemic complications compared to permanent embolic agents. This study evaluated the safety and effectiveness of TAE using QS-GSPs for acute lower gastrointestinal bleeding. Materials and Methods: This retrospective multicenter study analyzed patients who underwent TAE with QS-GSPs for acute nonvariceal lower GI bleeding between 2021 and 2024. Technical success (occlusion or stasis of blood flow in the target artery), clinical success (cessation of bleeding symptoms with hemodynamic stability during the week following TAE without major complications), and procedure-related complications were assessed. Results: A total of 29 patients (mean age 64.9 years) were included. Active bleeding was detected in 6 patients (20.7%) on angiography. Embolized arteries included jejunal (n = 7), ileal (n = 7), ileocolic anastomotic (n = 1), cecal (n = 2), colic (n = 7), and rectosigmoid (n = 5) arteries. QS-GSPs (150–350 μm (n = 10) or 350–560 μm (n = 19)), which dissolve completely within several hours, were used as the sole embolic agents. Technical and clinical success rates were 100% and 75.9% (22/29), respectively. Clinical failure occurred in seven patients (24.1%) due to persistent (n = 4) or recurrent (n = 3) bleeding within one week. Transient bowel ischemia occurred in two patients (6.9%) but resolved spontaneously. The clinical success rate did not differ significantly between patients with active bleeding (66.7%) versus those without (73.9%). Conclusions: TAE with QS-GSPs for acute lower GI bleeding demonstrated a favorable safety profile with clinical success exceeding 75%. Transient bowel ischemia occurred in 6.9% of patients with spontaneous resolution, and no bowel infarction was observed.