This systematic review and meta-analysis compares the safety and efficacy of atherectomy as a vessel preparation tool prior to balloon angioplasty (ATH + BA) versus balloon angioplasty alone (BA) for the treatment of peripheral arterial disease (PAD). Medline, Embase, CENTRAL, and Clinicaltrials.gov databases were searched for randomized controlled trials (RCTs) comparing ATH + BA versus BA alone in treating PAD. The outcomes analysed included primary patency, technical success, bailout stenting, flow-limiting dissection, clinically driven target lesion revascularization (CD-TLR), distal embolization, arterial perforation, major amputation, and all-cause mortality. A subgroup analysis was done to compare femoropopliteal versus infrapopliteal and plain balloon angioplasty versus drug-coated balloon. Seven RCTs met the inclusion criteria (489 patients). Atherectomy as vessel preparation was associated with reduced rates of bailout stenting (OR: 0.14, 95

INTRODUCTION:This narrative review examines endovascular treatments for acute pulmonary embolism (PE), focusing on percutaneous mechanical thrombectomy (MT). METHODS:PubMed (Medline) and Google Scholar were searched from January 1990 up to November 2024 (updated Feb 2026). Studies were included if they discussed PE and the use of thrombectomy devices. Full-text randomised controlled trial studies, observational studies, case series, and case reports were included. Opinion articles, letters to the editor, animal studies, and non-English studies were excluded. RESULTS:A total of 116 articles were reviewed. Current guidelines recommend systemic thrombolysis as first-line reperfusion for high-risk PE, whereas intermediate-high-risk PE is managed with anticoagulation and monitoring, with reperfusion reserved for deterioration. MT is currently an alternative, mainly when thrombolysis is contraindicated or has failed. However, the last two decades have seen a surge in thrombectomy devices including the FlowTriever, Indigo, and AngioVac. Numerous studies, most notably the PEERLESS trial, have reported rapid haemodynamic improvement with MT, including reduced pulmonary artery pressure, low major bleeding rates, and fewer intensive care admissions [1]. CONCLUSION:MT has shown early promise in the management of PE. Much of the current evidence derives from single-arm trials, registries, and industry-sponsored observational studies, with randomised comparative data still limited. Nonetheless, randomised evidence suggests MT may reduce clinical deterioration, intensive care use, and hospital length of stay compared with catheter-directed thrombolysis, though without a demonstrated difference in mortality, intracranial haemorrhage, or major bleeding. Further trial evidence is required before MT is recommended as first-line in PE.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is one of the preferred interventional radiology techniques for reducing clinically significant portal pressures in patients with cirrhosis and complications from portal hypertension when pharmacological therapy or endoscopic interventions have failed or been insufficient. Recent advances in TIPS procedural techniques and stent technology, along with emerging indications for TIPS, warrant a review of current practices and establishment of consensus recommendations in Australia, where TIPS remains underused. This TIPS consensus statement is the first such guideline in Australia. It outlines 69 evidence-based practice recommendations and the evidence underlying them. The recommendations are intended for use by health care professionals in Australia who manage adult patients with portal hypertensive complications of liver disease, where such patients are being considered for TIPS implantation, including pre-, peri- and post-procedural aspects of care. Methods and results: This consensus statement has been developed by specialists in hepatology and interventional radiology, with input from specialists in cardiology, hematology and primary care, including medical practitioners, nurses and clinical researchers. The statement deals with four domains related to TIPS: preparation for TIPS, patient selection and pre-TIPS workup; best procedural practice; postoperative care and follow-up; and indications for TIPS. Two rounds of a modified Delphi process were used to reach consensus on the recommendations. Conclusions: Adoption of and adherence to the evidence-based recommendations in this consensus statement should reduce clinical variation. Ultimately, this should lead to system-level improvements in quality of care and outcomes for patients undergoing TIPS implantation. These recommendations summarize the complete document, available at https://www.gesa.org.au/resources/ .

INTRODUCTION:Per-oral Image-guided gastrostomy (PIG) is an alternative to conventional radiologically inserted gastrostomy (RIG). PIG is less frequently used in Australia, despite a favourable complication profile reported within the literature. This case control study compares success and complication rates of these procedures at a quaternary Australian Hospital. METHODS:Retrospective review of electronic medical records (EMR) was performed for patients undergoing radiological-guided gastrostomy between January 2019 and January 2023. Clinical notes, operation reports, radiology reports and discharge summaries at the time and for subsequent readmissions within 3 months were reviewed. Outcomes measured included procedural indication, technical success rate, major and minor complications, readmission or death within 3 months. RESULTS:216 radiological guided gastrostomies were attempted (age 65.6 ± 12.6; range 20-93; 81 female and 135 male). Sixteen cases were abandoned prior to insertion. Gastrostomy was successful in 133/136 PIG (97.8%) and 63/64 RIG (98.4%). The most frequent indication for PIG was dysphagia secondary to Motor Neuron Disease (107/136) and for RIG was head and neck malignancy (41/64). There were significantly more major complications (15.6% vs. 6.6%, p = 0.043) and minor complications (14.0% vs. 2.9%, p = 0.003) with RIG compared to PIG. Tube malpositioning, leak/peritonitis, aspiration pneumonitis and tube dislodgement were significantly increased in RIG. There was no significant difference in readmission rate (5.1% for PIG vs. 9.4% for RIG) or mortality (2.2% vs. 7.8%). CONCLUSION:Compared to conventional RIG, PIG showed a similar primary success rate and decreased incidence of both major and minor complications.

Hepatocellular carcinoma (HCC) is an aggressive primary malignancy of the liver and is the third most common cause of cancer-related global mortality. There has been a steady increase in treatment options for HCC in recent years, including innovations in both curative and non-curative therapies. These advances have brought new challenges and necessary improvements in strategies of disease monitoring, to allow early detection of HCC recurrence. Current serological and radiological strategies for post-treatment monitoring and prognostication and their limitations will be discussed and evaluated in this review.

To meet the growing demand for interventional radiology (IR), more hospitals are investing in state-of-the-art angiography suites, but these are expensive investments. Both the initial construction cost and the ongoing operational costs are significant. For health services, it is important to commission an angiography suite that can satisfy both present and future healthcare demands to maximize the value of the initial expenditure and the opportunities provided by this ongoing investment. Smart angiography suites (SAS) could be the solution that future-proof angiography services. Similar to the smart operating theatre, SAS refers to the incorporation of audio-video technology and internet connectivity into the angiography suite.1 SAS has the ability to record high resolution audio-visual data from the angiography suite and stream it to a remote audience at low latency to enable bi-directional communication and collaboration. SAS, alongside other telemedicine concepts, have also gained new-found interest and relevance in light of the global coronavirus pandemic and the travel restrictions associated with this. We reviewed the current literature to provide an overview of the SAS, its potential, and associated legal and ethical considerations. For hospitals, SAS can be as rudimentary as a webcam or as advanced as a comprehensive commercial solution such as Olympus MedPrescence, Proximie, Tegus Medical, Sony Nucleus or InTouch Health VisitOR. In general, commercial solutions will include audio-video equipment setup, internet streaming and broadcasting setup, and an end-user viewing software. Most commercial solutions are compatible with pre-existing equipment (vendor neutral) (see figure 1 for an example solution). Different solutions also offer varying features of different video layouts, video freezing, telestration with or without augmented reality, integration with picture archiving and communication system, and security. The cost of a commercial SAS solution varies with each company offering a different type of license. Figure 1 An example of a smart angiography suite solution, from …

Abstract Purpose To outline the process of the STABILISE technique and its use; reporting patient outcomes and midterm follow up for complicated aortic dissection. Materials and methods Single centre retrospective analysis from January 2011 to January 2021 using the STABILISE technique which utilises balloon assistance to facilitate intimal disruption and promote aortic relamination. Results Sixteen patients underwent endovascular aortic repair with the STABILISE technique for aortic dissection over the study period. Fourteen patients (14/16; 88%) had acute dissection. Two of 16 (12%) were chronic. The median age of the patient cohort was 61 years (range 32–80 years) and consisted of a male majority (n = 11; 69%). The median time from diagnosis to intervention was 5 days (1–115 days; IQR 1–17.3). More than half (56%) had surgical repair of a acute type A aortic dissection prior to radiological intervention. The procedure was technically successful with no procedural mortality. Two patients were lost to follow up and two died in the post-operative period. Twelve patients had ongoing follow up with an average number of 2.9 ± 1.6 scans performed. Follow up was available in thirteen patients (81%) with a median follow up period of 1097 days (IQR 707–1657). The rate of re-intervention (n = 2/16; 13%) requiring additional stenting was in line with published re-intervention data (15%). Follow up showed a reduction in false lumen size following treatment with total luminal dimensions remaining stable over the follow-up period. Conclusion The STABILISE technique as a procedure for complicated aortic dissection, either acute or chronic, appears safe with stable mid-term aortic remodelling and patient outcomes. Level of evidence Level 3, Retrospective cohort study.

Purpose Arteriovenous malformations (AVMs) are abnormal communications between arteries and veins without an intervening capillary system. The best endovascular treatment option for these is unclear and may involve multiple staged procedures using a variety of embolic materials. We report our initial experience using a modified version of a previously published neurointerventional technique to treat soft tissue AVMs with single-stage curative intent. Materials and methods Soft tissue AVMs treated endovascularly using either sole arterial or combined arterial and venous balloon-assisted techniques with liquid embolic agents were retrospectively identified over a 3.5 year period (January 2017 to June 2020)) at two centres. Clinical, pre-operative radiological, procedural technical and post treatment details were recorded. Results Seven patients were treated for symptomatic soft tissue arteriovenous malformations. These AVMs were located in the peripheral limbs (five), tongue (one) and uterus (one). Curative treatment was achieved in 6/7 patients with one patient requiring a second treatment approximately 1 year later. A variety of liquid embolisation agents (LEAs) including sclerosants and polymers were used. Clinical success rate was 100% following treatment. One patient experienced expected temporary post-operative tongue swelling requiring tracheostomy occurred following embolisation of the lingual AVM. A minor complication in a second patient was due to an access site haematoma developed following treatment of the hand AVM requiring surgical intervention. No long-term sequelae or additional complications were observed. Conclusion Endovascular arterial and venous balloon assisted LEA embolization of soft tissue AVMs with curative intent is feasible. This technique may provide an alternative treatment option for achieving durable occlusion for complex soft tissue AVMs.

INTRODUCTION:Portal hypertension (PH) is associated with complications including refractory ascites and variceal haemorrhage and can be treated endovascularly with a Transjugular Intrahepatic Portosystemic Shunt (TIPS). Portal vein puncture during TIPS using real-time transabdominal ultrasound guidance is one of many portal vein puncture techniques and is seldom used compared with other methods. The purpose of this manuscript is to describe this technique and its associated procedural outcomes at a quaternary liver transplant hospital.METHODS:Clinical data of all patients who underwent ultrasound-guided TIPS at our institution between 1 January 2009 and 1 January 2019 were retrospectively obtained from electronic medical records and reviewed. Patient demographics, indications, procedural outcomes and complications were recorded.RESULTS:Forty-four ultrasound-guided TIPS procedures were performed during the study period. The most common indication for TIPS was refractory ascites (n = 26; 57%) and variceal haemorrhage (n = 12; 26%). Technical success rate was 100%. No intraprocedural complications occurred. Periprocedural complication rate was 35% (n = 16) with encephalopathy (n = 8; 17%) and sepsis (n = 5; 11%) the most common. One patient with sepsis died. No other TIPS-related deaths occurred. Median fluoroscopy time, contrast volume, air kerma and dose area product values for all procedures were 35 minutes (IQR 24-51), 100 ml (IQR 70-160), 0.95 Gy (IQR 0.50-1.53) and 127 Gycm2 (IQR 68.75-206), respectively.CONCLUSION:Transabdominal ultrasound-guided portal vein puncture during TIPS is safe and technically feasible. When compared to fluoroscopically guided methods, it is associated with lower intraprocedural complication rates, fluoroscopy times, contrast volumes and radiation doses in our experience. Radiation doses, FTs and contrast volumes were also considerably lower than recommended limits.

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

INTRODUCTION:Diabetic patients with peripheral arterial disease (PAD) are challenging to assess. Non-contrast magnetic resonance angiography (MRA) offers a safe alternative in patients with renal impairment. The study objective is to evaluate accuracy of lower limb quiescent-interval single-shot (QISS) MRA and pedal QISS-arterial spin-labelled (ASL) MRA for detection of significant stenosis in diabetic patients with PAD. METHODS:Combined QISS and QISS-ASL MRA was performed in 32 diabetic PAD patients (20 male, 12 female; mean 69 years; 8 with critical ischaemia). Two readers assessed haemodynamically significant (>50%) stenosis and diagnostic confidence on MRA, against digital subtraction angiography (DSA) as the reference standard, with subgroup analysis of patients with severe renal impairment (n = 7). Inter-reader agreement of stenosis and diagnostic confidence were evaluated. Test-retest reproducibility was evaluated in 10 subjects who underwent repeat MRA on a different day. RESULTS:At DSA, 262/645 segments (40.6%) had haemodynamically significant stenoses. MRA accuracy was 78.1% (478/612) and 75.6% (464/614), sensitivity 64.7% (161/249) and 77.5% (193/249), and specificity 87.3% (317/363) and 74.2% (271/365) for 2 readers. MRA accuracy was 80.9% and 80.7% for readers 1 and 2, respectively, in patients with severe renal impairment. QISS MRA but not pedal QISS-ASL MRA was considered of diagnostic image quality. Inter-reader agreement was moderate for stenosis (ĸ = 0.60) and diagnostic confidence (ĸ = 0.41). Test-retest reproducibility was high (ĸ = 0.87) and moderate (ĸ = 0.54) for individual readers. CONCLUSIONS:Quiescent-interval single-shot MRA has reasonable accuracy in a diabetic PAD population with high burden of disease, providing a non-contrast option in patients with renal impairment. QISS-ASL MRA requires further optimisation to be clinically feasible.

BACKGROUND:Visceral and renal artery aneurysms (VRAAs) are uncommon but are associated with a high mortality rate in the event of rupture. Endovascular treatment is now first line in many centres, but preservation of arterial flow may be difficult in unfavourable anatomy including wide necked aneurysms, parent artery tortuosity and proximity to arterial bifurcations. Endovascular stenting, and in particular flow-diversion, is used in neurovascular intervention to treat intracranial aneurysms but is less often utilised in the treatment of VRAAs. The CASPER stent is a low profile dual-layer braided nitinol stent designed for carotid stenting with embolic protection and flow-diversion properties. We report the novel use of the CASPER stent for the treatment of VRAAs. We present a case series describing the treatment of six patients with VRAAs using the CASPER stent.RESULTS:Six patients with unruptured VRAAs were treated electively. There were three splenic artery aneurysms and three renalartery aneurysms. Aneurysms were treated with the CASPER stent, with or without loose aneurysm coil packing or liquid embolic depending on size and morphology. All stents were successfully deployed with no immediate or periprocedural complications. Four aneurysms completely occluded after serial imaging follow up with one case requiring repeat CASPER stenting for complete occlusion. In one patient a single aneurysm remained patent at last follow up, A single case was complicated by delated splenic infarction and surgical splenectomy.CONCLUSION:Preliminary experience with the CASPER stent suggests it is technically feasible and effective for use in the treatment of VRAAs.

BackgroundFlow diverting stents have been used safely and effectively for the treatment of intracranial aneurysms, particularly for large and wide necked aneurysms that are not amenable to conventional endovascular treatment with coiling. The Surpass Streamline device (Stryker Neurovascular, MI, USA) is a relatively new and unique flow diverting stent which maintains constant device mesh density over varying vessel diameters. This may potentially provide advantages compared to other flow diverting stents in achieving aneurysmal occlusion.Case presentationTwo patients with VRAA were treated using the Surpass Streamline device. The first patient was a 65-year-old male with an incidental 2.4cm aneurysm originating from the hepatic artery near the gastroduodenal artery (GDA). The second patient was a 56-year-old male with an incidental 1.9cm renal aneurysm arising from an anterior inferior segmental branch of the left renal artery. A Surpass flow diverting stent was used to successfully exclude the aneurysm neck in both cases.Reduced flow was achieved in one patient (equivalent to O'Kelly-Marotta [OKM] Grade B1). Preserved flow and stagnation (equivalent to OKM Grade A3) was achieved in the other. There was preserved distal flow in the parent arteries. No immediate complications were encountered in either case. Complete occlusion of both aneurysms was seen on follow up CT angiographic imaging within 8-weeks.ConclusionsThe Surpass flow diverting stent can be used safely and effectively to treat VRAA. It should be considered in unruptured large and giant wide necked VRAAs aneurysms. Additional large prospective studies are required for further validation.

Vertebral compression fractures (VCFs) are a common cause of back pain and disability and are usually osteoporotic in nature. Therapy aims to adequately control pain and allow early mobilisation and return of function while preventing additional fractures. A proportion of patients do not achieve adequate pain relief using conservative measures alone. Unwanted adverse effects from medications may also ensue. Vertebroplasty represents an alternative treatment option for VCFs. Patients with acute VCFs (≤6 weeks old) may gain the most benefit from vertebroplasty as healed fractures are not as amenable to cement injection. High-quality studies have reported conflicting results regarding the use of vertebroplasty in the treatment of acute VCFs. Despite high-quality evidence, varying study designs and heterogenous patient cohorts make interpretation of this data difficult. Only one sham-controlled randomised controlled trial (RCT) has evaluated vertebroplasty exclusively in patients with acute VCFs, reporting favourable results. Pooled data from RCTs also suggest vertebroplasty to be safe. This article provides a concise and critical review of the current literature regarding vertebroplasty for the treatment of acute VCFs.

Advances in interventional radiology have seen the adaptation of urological endoscopic laser techniques to treat biliary tract calculi. Percutaneous transhepatic biliary laser lithotripsy provides an effective alternative procedure for the management of intrahepatic or conventionally refractory choledocholithiasis which would otherwise require invasive and high-risk surgical intervention. Several small studies have validated the procedure for management in this subset of patients, with most achieving 100% calculi clearance with minimal complications. Most patients are suitable for percutaneous transhepatic biliary laser lithotripsy. Preprocedural imaging is useful for evaluating stone burden and planning percutaneous access. Holmium lasers are commonly used and act by vaporising water particles on and in the calculi, fragmenting the stone via thermal expansion. A series of catheters, wires, sheaths and dilators are used to allow introduction of the choledochoscope and laser so that calculi can be targeted. Percutaneous transhepatic biliary laser lithotripsy is often used in conjunction with balloon dredging and biliary stricture dilatation. Only experienced interventionalists should perform this procedure, and users should be aware of associated hazards. Repeat percutaneous transhepatic cholangiography is routinely performed to confirm eradication of stones. Treatment of biliary calculi and obstruction is important in preventing diseases such as cholangitis and cirrhosis. For patients unsuitable for conventional treatment, percutaneous transhepatic laser lithotripsy is a safe and effective alternative when performed by experienced interventional radiologists. Preprocedural planning is imperative to procedure success.

The rapid progression of medical imaging technology and the ability to leverage knowledge from non-invasive imaging means that Interventional Radiologists (IRs) and Interventional Neuroradiologists are optimally placed to incorporate minimally invasive interventional paradigms into clinical management to advance patient care. There is ample opportunity to radically change the management options for patients with a variety of diseases through the use of minimally invasive interventional procedures. However, this will need to be accompanied by an increased clinical role of IRs to become active partners in the clinical management of patients. Unfortunately, the development of IR clinical presence has lagged behind and is reflected by declining rates of IR involvement in certain areas of practice such as vascular interventions. Current and future IRs must be willing to take on clinical responsibilities; reviewing patients in clinic to determine suitability for a procedure and potential contraindications, rounding on hospital inpatients and be willing to manage procedure related complications, which are all important parts of a successful IR practice. Increasing our clinical presence has several advantages over the procedure-driven model including enhanced patient knowledge and informed consent for IR procedures, improved rapport with patients and other clinical colleagues through active participation and engagement in patient care, visibility as a means to facilitate referrals and consistency of follow-up with opportunities for further learning. Many of the solutions to these problems are already in progress and the use of IR as a "hired gun" or "technician" is a concept that should be relegated to the past, and replaced with recognition of IRs as clinicians and partners in delivering modern high quality multidisciplinary team-based patient care. The following article will review the history of IR, the challenges facing this rapidly evolving profession and discuss recent developments occurring globally that are essential in maintaining expertise, securing future growth and improving patient outcomes in the modern multidisciplinary practice of medicine.

Objective: Non-contrast magnetic resonance angiography (NC-MRA) is an attractive technique for imaging peripheral arterial disease (PAD) in diabetic patients where arterial calcification and renal impairment are common.Our purpose was to evaluate patient perception of lower limb NC-MRA and compare this perception to that of digital subtraction angiography (DSA).Materials and Methods: Thirty-one diabetic patients (18 male, 13 female, mean age=69 years) with symptomatic PAD (critical ischemia, n=10) referred for DSA were prospectively recruited, and 1.5T quiescent-interval single-shot NC-MRA was performed before DSA (intervention performed during DSA, n=23).Patients rated anxiety, pain, discomfort, willingness to repeat (Likert scale: 1 most favorable to 7 least favorable), and difficulty compared to expectations (-3 better to +3 worse).Results: Twenty-nine patients' results were analyzed (DSA under general anesthesia, n=1; incomplete NC-MRA due to morbid obesity, n=1).NC-MRA and DSA median scores were 1 vs. 3, 1 vs. 2, 2 vs. 2, and 1 vs. 1 for anxiety, pain, discomfort, and willingness to repeat, respectively.The median score for difficulty compared to expectations was 0 (as expected) for both examinations.The anxiety and pain scores for NC-MRA were significantly lower than those for DSA (p=0.006 and p=0.001, respectively).Reasons for the less favorable NC-MRA experience included machine noise (n=3), pain from coil pressure (n=3), and claustrophobia (n=1). Conclusion:NC-MRA was well tolerated overall, and better than DSA for anxiety and pain.Although DSA is commonly required for intervention in PAD, NC-MRA may inform disease management and potentially obviate DSA where conservative management, or open surgery, are indicated.Reduced acoustic noise, lighter receiver coils, and wider scan bores may improve procedural tolerance.

Spinal metastases are the most commonly encountered tumour of the spine, occurring in up to 40% of patients with cancer. Each year, approximately 5% of cancer patients will develop spinal metastases. This number is expected to increase as the life expectancy of cancer patients increases. Patients with spinal metastases experience severe and frequently debilitating pain, which often decreases their remaining quality of life. With a median survival of less than 1 year, the goals of treatment in spinal metastases are reducing pain, improving or maintaining level of function and providing mechanical stability. Currently, conventional treatment strategies involve a combination of analgesics, bisphosphonates, radiotherapy and/or relatively extensive surgery. Despite these measures, pain management in patients with spinal metastases is often suboptimal. In the last two decades, minimally invasive percutaneous interventional radiology techniques such as vertebral augmentation and radiofrequency ablation (RFA) have shown progressive success in reducing pain and improving function in many patients with symptomatic spinal metastases. Both vertebral augmentation and RFA are increasingly being recognised as excellent alternative to medical and surgical management in carefully selected patients with spinal metastases, namely those with severe refractory pain limiting daily activities and stable pathological vertebral compression fractures. In addition, for more complicated lesions such as spinal metastasis with soft tissue extension, combined treatments such as vertebral augmentation in conjunction with RFA may be helpful. While combined RFA and vertebral augmentation have theoretical benefits, comparative trials have not been performed to establish superiority of combined therapy. We believe that a multidisciplinary approach as well as careful pre-procedure evaluation and imaging will be necessary for effective and safe management of spinal metastases. RFA and vertebral augmentation should be considered during early stages of the disease so as to maintain the remaining quality of life in this patient population group.

Khan, Saad A MBBS1; Pham, Cecilia MBBS1; Seah, Dean MBBS1; Ranatunga, Dinesh MBBS, FRANZCR, EBIR2; Gow, Paul J MD, FRACP1,3 Author Information