The role of systemic chemotherapy after immunotherapy failure in advanced hepatocellular carcinoma (HCC) remains poorly defined. We describe five patients with advanced HCC who progressed on immune checkpoint inhibitor-based therapy and subsequently received cytotoxic chemotherapy. Gemcitabine-, fluorouracil-, and platinum-based chemotherapy regimens, including hepatic arterial infusion chemotherapy in one patient, were administered. Three patients achieved a partial radiologic response, whereas two showed early disease progression. These descriptive observations suggest that, in carefully selected patients with preserved liver function and good performance status, chemotherapy may be associated with radiologic disease control after immunotherapy failure.

We aimed to report real-world outcomes of transarterial radioembolization (TARE) in patients with intrahepatic cholangiocarcinoma (ICC), focusing on different microsphere types and posttreatment dosimetric approaches in relation to dose–response and survival analyses. This multicenter retrospective single-arm cohort study included adult patients with intrahepatic cholangiocarcinoma treated with Y-90 glass or resin microspheres using lobar or segmental approaches between January 2014 and December 2024 across 13 centers. All posttreatment Y-90 Bremsstrahlung single photon emission tomography (SPECT)/ computed tomography (CT) or Y-90 positron emission tomography (PET) images were reviewed. Post-treatment dose estimations were performed centrally by a nuclear medicine physician with 10 years of experience in dosimetric calculations using the VoxelDosimetry tool of Hermia software (Hermes Medical Solutions, Sweden). Mean perfused liver absorbed dose (PLAD), mean tumor absorbed dose (TAD), and mean whole-liver absorbed dose (WLAD) were calculated. Dosimetric analysis for Y-90 SPECT/CT and PET/CT were performed separately. Tumor response was assessed by comparing imaging obtained within 6 weeks before treatment and 2–4 months after treatment. Response categories were grouped as objective response (complete response + partial response) and nonresponse (stable disease + progressive disease) for treated lesions. Hepatotoxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE) using serum Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), and bilirubin levels within 3 months after TARE. Additionally, albumin–bilirubin (ALBI) scores were calculated before and after treatment, and changes in ALBI grade were analyzed. Initially, data from 194 (110 female, 84 male; mean age 53.8 ± 16.6 years) patients were included. After excluding patients without survival status data, 180 patients were included in the overall survival (OS) analysis. Seventeen patients were excluded from dose–response evaluation due to suboptimal posttreatment Y-90 imaging for dosimetric calculations. Survival analyses were performed on a per-patient basis, whereas dosimetric and response analyses were performed on a per-treatment-session basis. For dose response analysis, a total of 194 TARE sessions in 163 (101 female, 62 male; mean age 51.4 ± 12.6 years) patients were analyzed. Median (min–max) of administered activities were 2.7 (1.4–6.1) GBq for glass microspheres and 1.4 (0.6–1.8) GBq for resin microspheres (p = 0.004). In separate analyses of SPECT and PET studies, higher TAD and PLAD values were observed in sessions analyzed with PET-based dosimetry (for mean TAD; 249.2 ± 26.6 Gy vs 114.8 ± 15.7 Gy, p < 0.001, for mean PLAD; 102.1 ± 10.4 Gy vs 59.4 ± 11.3 Gy, p = 0.031). A significant positive trend between TAD and response category was observed in the resin microsphere sessions using Y-90 PET–based dosimetry (Area Under Curve 0.693, p = 0.028). In the OS analysis of 180 patients (median follow-up 13.3 months, range 7–81), 128 deaths occurred. Medians of OS did not differ between patients treated with glass versus resin microspheres [17.4 (13.2–21.5, 95

To compare the acute (within 30 days of treatment) laboratory toxicities of Yttrium-90 (Y-90) resin and glass microspheres. Selective intra-arterial radionuclide therapies (SIRTs) with Y-90 resin and glass microspheres were retrospectively reviewed. Liver-hematological data were collected at baseline and at 1 week and 1 month follow-up. The percentage change of laboratory data and the albumin–bilirubin (ALBI) score were calculated. A total of 219 SIRTs (n: 110 resin, n: 109 glass) from 177 patients were included. There was no difference in age, liver pathologies, extrahepatic disease, baseline liver function tests, and total blood counts between the two microsphere groups. Administered activity was higher in treatments with Y-90 glass microspheres (p < 0.001). An increase in serum liver enzymes was observed after treatment with both microspheres. The difference between the treatment groups was the higher percentage increase of AST and ALT at the first week following Y-90 glass treatment (p < 0.001). However, this situation was not observed after 1 month. No difference in the percentage change of other laboratory parameters was found between two groups. The number of patients with an increase [resin n: 24 (24.7

Background/Aims: Demonstration of possible utero-ovarian anastomoses (UOA) before or during uterine artery embolization (UAE) is important to preserve ovarian reserve. This study aimed to evaluate the incidence and risk factors for the presence of type 1b or type 3 UOA in patients undergoing UAE for the treatment of uterine myomas. Methods: Procedural angiographies of patients who underwent UAE were evaluated in a single academic center. Patients’ demographics, indication for UAE, presence and type of UOA, presence of adnexal pathology at preprocedural MRI, history of pelvic surgery, and total uterine volume at preprocedural MRI were retrospectively evaluated. Analysis of the aforementioned variables between patients with and without UOA was performed. Results: This study included 30 patients with a mean age of 41.97±5.72 years (range 32 - 56). UOA was found in 17 (56.6%) patients, 10 (33.3%) of them were type 1b, and 7 (23.3%) of them were type 3. Five patients (17.2%) had adnexal pathology at pre-procedural MRI and 12 patients (40%) had a history of pelvic surgery. The mean total uterine volume was 607.1 cm3. In the analysis of variables between patients with and without UOA, UOA presence was significantly higher in patients with a history of pelvic surgery (p=0.005). All of the patients with a history of myomectomy were found to have type 1b or type 3 UOA. No significant relation between UOA and age, the presence of adnexal pathology, and uterine volume were detected. Conclusion: Utero-ovarian anastomoses are commonly encountered during UAE. A history of pelvic surgery was found to be a risk factor for the presence of type 1b and type 3 UOA.

Maintaining venous access and catheter patency in patients undergoing hemodialysis through the central catheter is a dire necessity. When conventional venous accesses have been exhausted, unconventional venous access techniques have become rational options to create vascular access for hemodialysis. Herein, a case with exhausted venous access, that underwent tunneled dialysis catheter insertion through subacutely occluded lower extremity central veins was described.

To study the molecular basis of TGEV tropism, a collection of recombinants between the PUR46-MAD strain of transmissible gastroenteritis coronavirus (TGEV) infecting the enteric and respiratory tracts and the PTV strain, which only infects the respiratory tract, was generated. The recombinant isolation frequency was about 10−9recombinants per nucleotide and was 3.7-fold higher at the 5′-end of the S gene than in other areas of the genome. Thirty recombinants were plaque purified and characterized phenotypically and genetically. All recombinant viruses had a single crossover and had inherited the 5′- and 3′-halves of their genome from the enteric and respiratory parents, respectively. Recombinant viruses were classified into three groups, named 1 to 3, according to the location of the crossover. Group 1 recombinants had the crossover in the S gene, while in Groups 2 and 3 the crossovers were located in ORF1b and ORF1a, respectively. The tropism of the recombinants was studied. Recombinants of Group 1 had enteric and respiratory tropism, while Group 2 recombinants infected the respiratory, but not the enteric, tract. Viruses of both groups differed by two nucleotide changes at positions 214 and 655. Both changes may be in principle responsible for the loss of enteric tropism but only the change in nucleotide 655 was specifically found in the respiratory isolates and most likely this single nucleotide change, which leads to a substitution in amino acid 219 of the S protein, was responsible for the loss of enteric tropism in the closely related PUR-46 isolates. The available data indicate that in order to infect enteric tract cells with TGEV, two different domains of the S protein, mapping between amino acids 522 and 744 and around amino acid 219, respectively, are involved. The first domain binds to porcine aminopeptidase N, the cellular receptor for TGEV. In the other domain maps a second factor of undefined nature but which may be the binding site for a coreceptor essential for the enteric tropism of TGEV.

Objectives: The study aimed to evaluate the effectiveness and reliability of transarterial embolization (TAE) in managing delayed bleeding after percutaneous nephrolithotomy (PNL). Materials and Methods: Patients presenting to our hospital’s emergency department with hematuria following PNL and treated with TAE were included in the retrospective analysis. Demographic, clinical, and radiological data were collected. Technical and clinical success rates of TAE were calculated. The impact of the embolization procedure on kidney function was determined using angiographic images, and pre- and post-procedure serum creatinine levels. Results: A total of 13 patients included in the study presented with intermittent visible hematuria. The average interval between hematuria onset and PNL was 11.92±7.27 days. No hemodynamic instability was observed in any patient. CT angiography identified vascular pathology in 11 patients (84.6%), who subsequently underwent renal angiography for TAE without conservative treatment. Pseudoaneurysms were found in 7 patients (63.6%), and both pseudoaneurysms and arteriovenous fistulae in 4 patients (36.4%). Technical success was achieved in all embolization procedures. Hematuria resolved in all patients during follow up with a clinical success rate of 100%. Renal parenchymal loss after embolization was <%10 in 8 patients (72.7%), %11-24 in 2 patients (18.2%), and %25-50 in 1 patient (7.7%). There was no significant difference in serum creatinine levels before (mean 1.09±0.53 mg/dl) and after (mean 1.06±0.71 mg/dl) TAE (p=0.5). No major procedure related complications were observed. Conclusions: TAE is an effective and safe method for the treatment of delayed bleeding following PNL. CT angiography facilitates diagnosis and treatment planning for patients with hematuria after discharge. Early TAE for patients with identified vascular pathology can increase technical and clinical success rates.

Purpose This study evaluated the results of polidocanol sclerotherapy in the treatment of venous malformations (VM) including patient satisfaction, perceived improvement, and predictors of satisfaction. Material and Method Patients with VM that underwent polidocanol foam sclerotherapy between June 2013 and July 2021 in a single center were retrospectively evaluated. Patient demographics, VM, and treatment characteristics were analyzed. Patient-reported outcomes and satisfaction were analyzed with a questionnaire. Results This study included 232 (136, 58.6%, female) patients. The mean age was 24.49 ± 12.45 years (range 3–72). The clinical response rate was 82.3%. The rate of satisfaction was 82.3%, and 116 (50%) patients were significantly satisfied. There were no major complications. Clinical response and VM margin were related to satisfaction (p < 0.01, p = 0.012, respectively). Clinical response to pretreatment swelling was related to significant satisfaction (p = 0.02). Conclusion Polidocanol sclerotherapy was safe and effective in VM treatment with high satisfaction and low complication rates.

PURPOSE Patients with arteriovenous malformations (AVMs) have a lower health-related quality of life (QoL) than the general population. QoL assessment of patients with peripheral AVMs after endovascular treatment is scarce in the literature. Radiologic and clinical outcomes are not always correlated in vascular malformation treatment. This study aimed to investigate the relationship between clinical outcomes, QoL, and angiographic outcomes. MATERIALS AND METHODS Patients with peripheral AVM that underwent endovascular treatment between January 2009 and December 2021 in a single center were retrospectively evaluated. Patients' characteristics (age, sex), AVM characteristics (Schobinger classification, location, angiographic architecture), previous treatment, treatment characteristics (type of endovascular approach, embolizing agent and number of sessions), percentages of angiographic response, complications, and recurrence were evaluated. The angiographic architecture was evaluated according to the Yakes classification. The questionnaire was applied for evaluation of clinical response and QoL. Patients older than 12 years and those who can be contacted were included in clinical and QoL analysis. Clinical response was defined as improvement in the patient's most important pretreatment symptom. Treatment response was defined as clinical response plus >50% angiographic response. RESULTS Eighty-six patients (41 males [47.7%], 45 females [52.3%]) were included in angiographic analysis. The mean age was 28.44±12.99 years (range=5-61). Forty-three patients (50%) had previous treatment. The median number of sessions was 2 (range 1-15, InterQuartile Range [IOR]=2). Sixty-one patients (30 males [49.2%], 31 females [50.8%]) were included in clinical analysis. The clinical response rate was 73.8%, 95% confidence interval (CI) [0.60, 0.84]. The treatment response rate was 45.9%, 95% CI [0.33, 0.59]. The complication rate was 8.2%. Before treatment, 48 patients (78.7%) reported a negative impact on their QoL. Thirty-three of 48 patients (68.8%) reported improvement on their QoL after treatment. Higher Schobinger stages were related to a negative impact on QoL before treatment (p<0.01). Yakes types were not related to QoL (p=0.065). Clinical response was related to improvement on QoL after treatment (p<0.01). Angiographic and treatment responses were not related to improved QoL after treatment (p=0.52 and p=0.055, respectively). CONCLUSION Angiographic architecture and outcomes were not always reflected in QoL after endovascular treatment. CLINICAL IMPACT This study's findings will help clinicians with what to focus on in AVM treatment and how to monitor patients with peripheral AVM after endovascular treatment. Rather than relying too much on the angiographic response, patients should be checked for symptoms and quality of life improvement. No clear data in the literature regarding the applicability of the Yakes Classification in patients with previous treatment. This study questioned the applicability of the Yakes Classification in patients with previous treatments. In this study, type 4 AVMs were more common in patients with previous treatment.

Objective Chronic periaortitis (CP) is a less known but more frequently diagnosed fibro-inflammatory disorder, but we know little about it and data regarding follow-up and outcome are still very limited. This study aims to identify the clinicopathologic, laboratory, and radiologic features, as well as outcomes of CP patients. Methods Patients with CP from HUVAC database were included in the study. CP was diagnosed based on compatible imaging findings and histopathological evaluation (if available), in addition to clinical findings. Demographics, laboratory, clinical, and imaging data were retrospectively reviewed from medical records. Results A total of 51 (male/female:37/14) patients were included in the study. Median (IQR) age was 63 (53-69) years and follow-up duration was 40 (4-60) months. 32 of the patients were IgG4-related CP. The most common form of CP in our cohort was idiopathic retroperitoneal fibrosis (82%), followed by inflammatory abdominal aortic aneurysms (12%) and peri-aneurysmal retroperitoneal fibrosis (8%). 8 (15.6%) patients had thoracic periaortitis and 16 (31.6%) venous involvement. Cyclophosphamide (CYC) combined with steroids was the most preferred treatment modality (43%), followed by rituximab (RTX) (31.3%). Follow-up imaging was done after a median (IQR) of 7 (3-11) months, 30% of the patients were stable and 64.1% showed regression. A total of 18 (35.2%) had been taken off therapy at the last visit. Conclusion Idiopathic retroperitoneal fibrosis was the most frequent presentation, whereas 15.6% of patients had thoracic involvement. Venous involvement was also not uncommon. Optimal time for follow-up imaging was determined as 6-9 months. Steroids along with CYC/RTX had a favourable outcome in the treatment of these patients.

PURPOSE This study evaluated single center results of endovascular treatment in renal angiomyolipoma (AML) to determine whether there is clinical relevance of adding proximal coil embolization to distal particle embolization in terms of safety, efficacy and retreatment rates. METHODS A retrospective analysis was performed to evaluate patients undergoing transarterial embolization for renal AMLs from January 2007 to October 2020. Parameters regarding patient and tumor characteristics, embolization technique, treatment outcome and complications were recorded. Patients were divided into two groups as A (only particle group) and B (particle + coil group) based on the type of embolic agent used for treatment. Comparative analysis was performed between the two groups in terms of tumor size reduction, retreatment and complication rates. RESULT Forty-two patients (37 (88.1%) female, 5 (11.9%) male) harboring 48 AMLs were included in the study. The mean age was 43.46 (range 20 to 78). The technical success rate was 95.8% (46 of 48 procedures). The mean size reduction was 1.94±1 cm (p < 0.001) after treatments however, no significant difference was seen between groups in terms of tumor size reduction. Retreatment rates were 3.1% (1 of 32 cases) in group A and 14.3% (2 of 14 cases) in group B (p = 0.21). No significant difference was found between groups in terms of bleeding and complication rates during the perioperative period. Mean follow-up duration was 26.48±25.71 (range from 2 to 102) months. CONCLUSION In this study, no clear supplementary benefit was observed in terms of safety, and efficacy with the adjunction of coils to distal particle embolization in the management of AMLs.

OBJECTIVES The aim of our study was to evaluate the safety and efficacy of percutaneous treatment of ureteral obstructions and leak after renal transplant and to evaluate the long-term results and graft survival rates in a single center. MATERIALS AND METHODS This retrospective study included 27 transplant recipients who received percutaneous treatment between January 2000 and December 2010 and who had follow-up data until December 2018. During this period, 294 renal transplants were performed at our institution, with 17 (5.7%) having a ureteral complication. Ten patients included in the study had their transplants at another center. Percutaneous nephrostomy, balloon dilatation, and double J stent placement were used in the management of complications. Cutting balloon dilatation and tandem ureteral stent placement were done in cases of resistant stenosis. Technical success and ureter patency rates were calculated. Graft survival rates were compared between early and late obstruction groups and between successful and unsuccessful interventional treatment. RESULTS Among included cases, 21 obstructions (7 early, 13 late) and 8 leaks were detected. The technical success rate of percutaneous nephrostomy was 100% in all groups. The technical success rates of balloon dilatation and double J stent were 100% and 88% in the early and late obstruction groups, respectively. Censored graft survival rates in all groups at 1, 5, and 10 years were 89%, 89%, and 73.9%, respectively. In long-term follow-up, ureter patency rates were 100%, 33%, and 50% for early obstruction, late obstruction, and urinary leak groups, respectively (P = .018). Graft survival rates between early and late obstruction groups were not significantly different. No major complication, allograft loss, or 30-day mortality was seen. CONCLUSIONS Percutaneous management of ureteral complications is safe and effective and should be considered as first-line treatment because of its less invasive nature and lower complication and morbidity rates.

Background/aim:Prostatic artery embolization (PAE) is a minimally invasive effective method in the treatment of benign prostatic hyperplasia (BPH). The procedure is technically challenging, as pelvic vascular anatomy is highly prone to variations and the identification of the prostatic artery (PA) is the most time-consuming step, which can lead to increased procedure times. The aim of this study was to categorize the anatomic variations in the prostatic supply in patients with BPH treated with PAE.Materials and methods:The digital subtraction angiography findings of 68 PAE procedures were reviewed retrospectively and the age, PA origin, number, and procedure of the patients were recorded. The origin of the PA was classified into 5 subtypes using the de Assis/ Carnavale classification. The incidence of each anatomic type was calculated.Results:In the 68 PAE procedures, 119 pelvic sides were analyzed and a total of 119 PAs were classified. The most common origin was type 1 (n = 43, 36.1%), with the PA originating from the anterior division of the internal iliac artery (IIA), from a common trunk with the superior vesical artery. This was followed by type 4 (n = 34, 28.6%), with the PA originating from the internal pudendal artery; type 3 (n = 22, 18.5%), with the PA originating from the obturator artery; and type 2 (n = 13, 10.9%), with the PA originating from the anterior division of the IIA.Conclusion:Anatomic variations are common in the IIA and PA, showing racial and individual differences. Following a standard classification system to identify the origin of the PA is crucial and being aware of the most common types in each population will make PAE a faster and safer procedure.

Secondary hyperparathyroidism is one of the most common complications of chronic kidney failure. If prolonged, parathyroid hormone release gains autonomy and tertiary hyperparathyroidism with parathyroid adenoma or hyperplasia can be develop. Tertiary hyperparathyroidism is associated with increased risk of mortality and morbidity; thus, treatment is recommended. Medical treatment includes phosphate binders, vitamin D analogues, and calcimimetic agents. Most cases of tertiary hyperparathyroidism can be controlled with medical treatment. When medical treatment options prove insufficient, parathyroidectomy is recommended. However, recurrence after parathyroidectomy is possible, which requires an alternative treatment. We present our percutaneous embolization experience, which has not been tried in the treatment of tertiary hyperparathyroidism in renal transplantation patients diagnosed with tertiary hyperparathyroidism.

(TIAPs) are reported to be safe and well-accepted among cancer patients.1 TIAPs are useful in the management of patients who require multiple chemotherapy sessions, parenteral nutrition, prolonged intravenous drug treatment (with antibiotics, etc.), and repeated drawing of blood. Moreover, chemotherapeutic agents are associated with less venous toxicity when administered via the central venous route. Most cases of TIAPs remain complication-free until treatment completion or death and present a complication rate of 19% during the entire duration of device usage.1 In the case report presented here, a rare complication of TIAPs-peri-catheter fibrin sheath calcification mimicking a retained catheter fragment-is described to increase the awareness of this condition among medical professionals.