To evaluate the visualization of the ice ball during cryoablation of vertebral bodies and the bony pelvis in an in vivo swine model using virtual non-calcium imaging (VNCa) derived from photon-counting detector computed tomography (PCD-CT). Cryoablation was performed at six locations in the spine and pelvis of three live swine. Spectral ultra-high resolution image acquisition using PCD-CT was conducted before ablation and at 2, 4, 6 and 8 min after initiation of the cryoablation cycle. Artifacts were suppressed using iterative metal artifacts reduction. Ice ball visualization within bone and soft tissue was assessed on both, conventional and VNCa images. At each time point the presence and size of the ice ball visualization was evaluated. A total of 12 needle placements was analyzed. In conventional images the ice ball could not be seen within bone at any time. In contrast, in VNCa images the ice ball became visible after 2 min in all cases. However, the ice ball was less clearly visualized in the soft tissue on VNCa images. Mean ice ball volume at 2, 4, 6, 8 min was 1.6 ± 0.9, 2.8 ± 1.7, 5.5 ± 2.9 and 8.3 ± 3.2 ml in the vertebral bodies and 0.8 ± 0.3, 2.0 ± 0.4, 4.4 ± 0.6, 6.2 ± 1.1 ml in the bony pelvis, respectively. PCD-CT enables early visualization of the ice ball within vertebral bodies and the bony pelvis in a swine model using VNCa images.

Background: The parallel stent graft endovascular aortic repair (PGEVAR) technique is an off-the-shelf option used for elective complex abdominal aortic aneurysm repair with acceptable outcome results, as reported so far. The PGEVAR technique, using chimney or periscope parallel grafts, can also be used for patients with ruptured complex abdominal aortic aneurysms. However, only few data about the mid- to long-term outcomes are available. Methods: Data from patients treated between August 2009 and July 2023 with the PGEVAR technique for ruptured complex abdominal aortic aneurysms were analyzed. The endpoints of this study were primary and secondary technical success, perioperative mortality, rate of proximal type 1a (gutter) endoleaks (T1aEL), and overall and aneurysm-related survival. Secondary endpoints were major adverse events, durability of parallel grafts, and factors associated with overall survival. Results: Twenty patients (mean age: 77 ± 9 y; 18 male) with ruptured complex abdominal aortic aneurysm were treated, receiving PGEVAR for ruptured juxtarenal (n = 11), suprarenal (n = 7), or distal thoracoabdominal Crawford IV aortic aneurysms (n = 2) with a mean diameter of 82 ± 18 mm (range 59–120). The patients had PGEVAR with implantation of 39 parallel grafts (1.95 PGs per patient; 23 chimney and 16 periscope) for revascularization of the celiac artery (n = 3), superior mesenteric artery (n = 9), and renal arteries (n = 27). Three patients had delayed PG implantation within 10 days. Primary technical success was 15/20 (75%) with five patients having an early proximal T1aEL, three of them having successful reintervention (secondary success rate: 18/20; 90%), with no persistent bleeding. Two patients had late T1aELs. The presence of an early T1aEL was related to the number of PGs (≥2) implanted (p = 0.038) or insufficient aortic SG oversizing (p = 0.038). In-hospital mortality was 1/20 (5%). Perioperative mortality up to 32 days was 3/20 (15%), with two further late aneurysm-related deaths and eight late aneurysm-unrelated deaths (overall mortality 13/20; 65%) during follow-up (median 34 months; range 1–115). Major adverse events were observed in 11 (55%) patients. Secondary parallel stent graft patency at 1 and 3 years was 97.4 and 94.1%. During follow-up, aneurysm sac behavior was determined in 19 patients, which showed diameter progression (n = 3), stable aneurysm disease (n = 3), and aneurysm diameter regression in 13 (68.4%) patients. Overall survival was 75% after 1 year, and 53% and 22% after 3 and 5 years. Factors associated with overall long-term survival were age < 80 years (p = 0.037), juxtarenal aneurysms (p = 0.023), the absence of major adverse events (p = 0.025), and aneurysm sac regression (p = 0.003). Conclusions: Treatment of ruptured complex abdominal aortic aneurysm with the PGEVAR technique is associated with acceptable perioperative and long-term outcomes with high PG patency rates. Early proximal T1aELs are observed with a relevant frequency, requiring early reintervention with successful sealing of most relevant endoleaks. To note, limitation of the number of parallel stent grafts implanted at the proximal aortic sealing sites, sufficient PG sealing length, and adequate main aortic SG oversizing are most relevant to avoid T1a (gutter) ELs. The selection of juxtarenal aortic aneurysms and evidence for aneurysm sac diameter regression after PGEVAR had a prognostic impact.

Objective:Pulmonary endarterectomy (PEA) is the gold standard for operable chronic thromboembolic pulmonary hypertension (CTEPH), an often underdiagnosed and undertreated disease. Before 2015, Swiss patients had limited access to PEA and were operated abroad, highlighting the need for a CTEPH center in Switzerland despite its small population. We herein summarize our 10-year PEA experience, its influence on patient outcomes, and analyze potential prognosticators for complications and long-term outcomes. Methods:Prospectively collected records of patients with CTEPH undergoing PEA at our institution (January 2015-December 2024) were retrospectively analyzed for perioperative and long-term outcome parameters, prognosticators for complications, and hemodynamic improvement. A benchmark analysis compared our center's results with the International CTEPH Registry. Results:Our cohort included 141 patients with CTEPH undergoing PEA, with 85 (60.3%) male patients and a median age of 62 years (range, 51-71 years). We observed significant improvements in mean pulmonary arterial pressure (mean difference, 16.6 mm Hg; P < .0001), pulmonary vascular resistance (mean difference, 3.7 WU; P < .0001), 6-minute walk test (mean difference, 68.8 m; P < .0001), oxygen requirement (χ2 = 6.3%; P = .018), New York Heart Association functional classification (rank difference statistic = -8%; P < .0001), and quality of life (Lin coefficient = 13.7 points; P = .004) after PEA. In-hospital and 90-day mortality were 2.8% (n = 4). Jamieson IV (odds ratio, 4.22; P = .039) and N-terminal pro B-type natriuretic peptide (odds ratio, 1.5; P = .039) were associated with postoperative complications. A stronger immediate postoperative decrease in mean pulmonary arterial pressure (mean difference, 0.7 mm Hg; P < .0001) and pulmonary vascular resistance (mean difference, 0.4 WU; P < .0001) predicted better long-term hemodynamic outcomes. Benchmark analysis showed comparable results with International CTEPH Registry data. Conclusions:Establishing a PEA program in Switzerland enabled timely, gold standard care for patients with CTEPH. Despite being a small-volume program, outcomes were comparable with high-volume centers. N-terminal pro B-type natriuretic peptide, Jamieson IV, and initial hemodynamic improvements emerged as prognosticators, warranting prospective validation.

OBJECTIVES:Chronic thromboembolic pulmonary hypertension is a rare disease, characterized by delays in diagnosis and curative surgical treatment. After establishing a surgical pulmonary endarterectomy centre in Switzerland and due to a historically low resection rate of 14%, a national multidisciplinary evaluation board was established in January 2018. Herein, we summarize the impact of the board on our programme. METHODS:Patients discussed in the national chronic thromboembolic pulmonary hypertension board from January 2018 to December 2023 were included. Clinical characteristics, treatment allocation and survival were compared between patients undergoing surgery, patients refusing surgery and non-operable patients. Fisher's exact test or three-way ANOVA and Kaplan-Meier analyses were used. RESULTS:188 patients were discussed at our national chronic thromboembolic pulmonary hypertension board; 131 (70%) presented with operable disease, 77 (41%) were referred for pulmonary endarterectomy and 34 (18%) of operable patients declined surgery. There is a significant difference in survival between these groups (P = 0.048). One- and 2-year survival in the subgroup undergoing pulmonary endarterectomy was 97% and 79%, respectively, while 1- and 2-year survival in the subgroup refusing pulmonary endarterectomy was 91% and 76%, respectively. The pulmonary endarterectomy rate has increased from a historical low of 14-41% since establishing the board. CONCLUSIONS:Establishing an interdisciplinary board is essential to address diagnostic and management challenges in chronic thromboembolic pulmonary hypertension patients. The Swiss national chronic thromboembolic pulmonary hypertension board played an important role in substantially increasing the rate of curative surgery.

To evaluate the feasibility and outcome of percutaneous biliary neo-anastomosis (PBNA) by means of fluoroscopy-guided enteral/biliary puncture, followed by temporary percutaneous transhepatic biliary drainage (PTBD). Four patients (25

Background:Recent advances in robotic microsurgery have enabled the application of robotic technology in central lymphatic reconstruction. Although the use of microsurgical robots demands careful consideration of associated costs and potentially prolonged operating times, it may offer improved surgical approaches and enhanced accessibility to deeper anatomical structures such as the thoracic duct (TD).Methods:We report on successful reconstruction of the central lymphatic system using the Symani Surgical System in four patients with lesions of the central lymphatic system. The patients were of different age (range: 8 mo-60 y) and had variable conditions, including central conducting lymphatic anomaly and other rare anomalies of the central lymphatic pathways.Results:Depending on the underlying pathology, a cervical access (n = 1) or median laparotomy (n = 3) was chosen to access the TD and perform anastomosis with a nearby vein. In all patients, anastomoses were patent, and chyle leakage decreased postoperatively. From a surgical perspective, the Symani Surgical System improved the precision of the microsurgeon and accessibility to the deep-lying TD.Conclusion:Considering the high morbidity and rarity of pathologies of the central lymphatic system, robotic-assisted microsurgery holds substantial promise in expanding and improving the microsurgical treatment for central lymphatic anomalies.

IntroductionIn recent years advances have been made in the microsurgical treatment of congenital or acquired central lymphatic lesions. While acquired lesions can result from any surgery or trauma of the central lymphatic system, congenital lymphatic lesions can have a variety of manifestations, ranging from singular thoracic duct abnormalities to complex multifocal malformations. Both conditions may cause recurrent chylous effusions and downstream lymphatic congestion depending on the anatomical location of the thoracic duct lesion and are associated with an increased mortality due to the permanent loss of protein and fluid.MethodsWe present a case series of eleven patients undergoing central lymphatic reconstruction, consisting of one patient with a cervical iatrogenic thoracic duct lesion and eleven patients with different congenital thoracic duct lesions or thrombotic occlusions.ResultsAnastomosis of the thoracic duct and a nearby vein was performed on different anatomical levels depending on the underlying central lymphatic pathology. Cervical (n = 4), thoracic (n = 1) or abdominal access (n = 5) was used for central lymphatic reconstruction with promising results. In 9 patients a postoperative benefit with varying degrees of symptom regression was reported.ConclusionThe presented case series illustrates the current rapid advances in the field of central microsurgical reconstruction of lymphatic lesions alongside the relevant literature.

BACKGROUND:Fontan-associated liver disease is an increasing concern. Our aim was to assess prevalence and predictors of advanced liver fibrosis with a specific focus on utility of liver stiffness measurement by ultrasound transient elastography. METHODS:A total of 97 adult Fontan patients (55% male, median age: 23.1 years, interquartile range [IQR]: 18.7-30.6); 92 (95%) were evaluated with transient elastography, and 50 (52%) underwent transjugular liver biopsy. Advanced liver fibrosis was defined as congestive hepatic fibrosis score 3 or 4. RESULTS:Only 4 patients (4%) had liver stiffness values < 10 kilopascal (kPa). Liver-stiffness measurements correlated weakly with peak oxygen uptake on exercise testing and Fontan pressure but not with Model for End-Stage Liver Disease excluding INR (MELD-XI) score or spleen size. Serial follow-up liver stiffness measurements in 73 clinically stable patients showed large variability among individual patients. Advanced liver fibrosis was present in 35 of 50 (70%) patients on liver biopsy and was associated to MELD-XI-Score ≥ 11 and splenomegaly but not to liver-stiffness measurements. Advanced liver fibrosis was not associated with patient age or time since Fontan operation but with younger age at completion of Fontan (3.7 years, IQR: 2.3-6.3 vs 6.8 years; IQR: 3.5-12.1; P = 0.037). CONCLUSIONS:In our cohort, advanced liver fibrosis was present in the majority of adult Fontan patients. Liver stiffness as measured by transient elastography was not associated with the degree of liver fibrosis. Because of its high variability on serial measurements, it seems not to be useful for clinical decision making. The unexpected finding that younger age at completion of Fontan was associated with advanced liver fibrosis merits further evaluation.

Objectives The aim of this study was to compare image quality and endoleak detection after endovascular abdominal aortic aneurysm repair between a triphasic computed tomography (CT) with true noncontrast (TNC) and a biphasic CT with virtual noniodine (VNI) images on photon-counting detector CT (PCD-CT). Materials and Methods Adult patients after endovascular abdominal aortic aneurysm repair who received a triphasic examination (TNC, arterial, venous phase) on a PCD-CT between August 2021 and July 2022 were retrospectively included. Endoleak detection was evaluated by 2 blinded radiologists on 2 different readout sets (triphasic CT with TNC-arterial-venous vs biphasic CT with VNI-arterial-venous). Virtual noniodine images were reconstructed from the venous phase. The radiologic report with additional confirmation by an expert reader served as reference standard for endoleak presence. Sensitivity, specificity, and interreader agreement (Krippendorf α) were calculated. Image noise was assessed subjectively in patients using a 5-point scale and objectively calculating the noise power spectrum in a phantom. Results One hundred ten patients (7 women; age, 76 ± 8 years) with 41 endoleaks were included. Endoleak detection was comparable between both readout sets with a sensitivity and specificity of 0.95/0.84 (TNC) versus 0.95/0.86 (VNI) for reader 1 and 0.88/0.98 (TNC) versus 0.88/0.94 (VNI) for reader 2. Interreader agreement for endoleak detection was substantial (TNC: 0.716, VNI: 0.756). Subjective image noise was comparable between TNC and VNI (4; IQR [4, 5] vs 4; IQR [4, 5], P = 0.44). In the phantom, noise power spectrum peak spatial frequency was similar between TNC and VNI (both fpeak = 0.16 mm−1). Objective image noise was higher in TNC (12.7 HU) as compared with VNI (11.5 HU). Conclusions Endoleak detection and image quality were comparable using VNI images in biphasic CT as compared with TNC images in triphasic CT offering the possibility to reduce scan phases and radiation exposure.

Summary:. Advances in the development of robotic systems have recently enabled the use of robotic technology in reconstructive lymphatic surgery. Although the advantages of microsurgical robots must be weighed carefully against the costs, their use may allow for smaller surgical approaches and easier access to anatomically deeper structures or even smaller vessels. We report on a case of a patient with central lymphatic dilation causing abdominal pain and severely reduced physical capacity. Sonography-assisted intranodal injection of indocyanine green allowed for localization of the lymphatic cyst and anastomosis with the left ovarian vein, applying robotic-assisted microsurgery for the first time on the central lymphatic system. Following the successful reconstruction of lymphatic drainage and decompression of the cyst, the patient reported a complete regression of her preoperative symptoms. From a surgical point of view, the Symani Surgical System improved precision and allowed significantly smaller surgical access. Considering the high morbidity and rarity of pathologies of the central lymphatic system, central lymphatic surgery is to date rarely performed. With improved precision and significantly smaller surgical access, robotic-assisted microsurgery has great potential to expand the treatment options for central lymphatic lesions.

OBJECTIVES:The aim of this study was to compare image quality and endoleak detection after endovascular abdominal aortic aneurysm repair between a triphasic computed tomography (CT) with true noncontrast (TNC) and a biphasic CT with virtual noniodine (VNI) images on photon-counting detector CT (PCD-CT).MATERIALS AND METHODS:Adult patients after endovascular abdominal aortic aneurysm repair who received a triphasic examination (TNC, arterial, venous phase) on a PCD-CT between August 2021 and July 2022 were retrospectively included. Endoleak detection was evaluated by 2 blinded radiologists on 2 different readout sets (triphasic CT with TNC-arterial-venous vs biphasic CT with VNI-arterial-venous). Virtual noniodine images were reconstructed from the venous phase. The radiologic report with additional confirmation by an expert reader served as reference standard for endoleak presence. Sensitivity, specificity, and interreader agreement (Krippendorf α) were calculated. Image noise was assessed subjectively in patients using a 5-point scale and objectively calculating the noise power spectrum in a phantom.RESULTS:One hundred ten patients (7 women; age, 76 ± 8 years) with 41 endoleaks were included. Endoleak detection was comparable between both readout sets with a sensitivity and specificity of 0.95/0.84 (TNC) versus 0.95/0.86 (VNI) for reader 1 and 0.88/0.98 (TNC) versus 0.88/0.94 (VNI) for reader 2. Interreader agreement for endoleak detection was substantial (TNC: 0.716, VNI: 0.756). Subjective image noise was comparable between TNC and VNI (4; IQR [4, 5] vs 4; IQR [4, 5], P = 0.44). In the phantom, noise power spectrum peak spatial frequency was similar between TNC and VNI (both f peak = 0.16 mm -1 ). Objective image noise was higher in TNC (12.7 HU) as compared with VNI (11.5 HU).CONCLUSIONS:Endoleak detection and image quality were comparable using VNI images in biphasic CT as compared with TNC images in triphasic CT offering the possibility to reduce scan phases and radiation exposure.

BACKGROUND:The heterogeneous quality of studies on arteriovenous fistulas outcome, with variable clinical settings and large variations in definitions of patency and failure rates, leads to frequent misinterpretations and overestimation of arteriovenous fistula patency. Hence, this study aimed to provide realistic and clinically relevant long-term arteriovenous fistula outcomes.METHODS:We retrospectively analyzed all autologous arteriovenous fistulas at our center over a 10-year period (2012-2022). Primary and secondary patency analysis was conducted using the Kaplan-Meier method; multivariate analysis of variance was used to detect outcome predictors. Vascular access-specific endpoints were defined according to the European guidelines on vascular access formation.FINDINGS:Of 312 arteriovenous fistulas, 57.5% (n = 181) were radio-cephalic (RC_AVF), 35.2% (n = 111) brachio-cephalic (BC_AVF), and 6.3% (n = 20) brachio-basilic (BB_AVF). 6, 12, and 24 months follow-up was available in 290 (92.1%), 282 (89.5%), and 259 (82.2%) patients, respectively. Primary patency rates at 6, 12, and 24 months were 39.5%, 34.8%, and 27.2% for RC_AVF, 58.3%, 44.4%, and 27.8% for BC_AVF, and 40.0%, 42.1%, and 22.2% for BB_AVF (p = 0.15). Secondary patency rates at 6, 12, and 24 months were 65.7%, 63.8%, and 59.0% for RC_AVF, 77.7%, 72.0%, and 59.6% for BC_AVF, and 65.0%, 68.4%, and 61.1% for BB_AVF (p = 0.29). Factors associated with lower primary and secondary patency were hemodialysis at time of arteriovenous fistula formation (p = 0.037 and p = 0.024, respectively) and higher Charlson Comorbidity Index (p = 0.036 and p < 0.001, respectively). Previous kidney transplant showed inferior primary patency (p = 0.005); higher age inferior secondary patency (p < 0.001).DISCUSSION:Vascular access care remains challenging and salvage interventions are often needed to achieve maturation or maintain patency. Strict adherence to standardized outcome reporting in vascular access surgery paints a more realistic picture of arteriovenous fistula patency and enables reliable intercenter comparison.

Congenital and acquired lesions of the central lymphatic system represent rare entities with a significant morbidity. The optimal treatment strategy remains elusive given limited evidence and a variety of different treatment options. Based on the treatment of four patients with anomalies or lesions of central lymphatic system of different origin, we aimed to elaborate an interdisciplinary treatment algorithm. Between 2018 and 2020, two patients with a central conducting lymphatic anomaly (CCLA), a massively dilatated TD, and consecutive chylous reflux were treated. Conservative treatment comprising dietary restrictions and application of octreotide did not have any effect. Given the high risk to worsen the chylous reflux by interventional embolization, both patients underwent lymphovenous anastomosis (LVA) leading to full remission in one patient, and partial remission in the second. A patient with postoperative chylous fistula after neck dissection was treated similarly and also showed complete remission. In contrast, one patient was diagnosed with a spontaneous TD rupture which resolved spontaneously. Patients were followed until 2 years postoperatively including clinical presentation, abdominal sonography, thoracic x-ray, and magnetic resonance lymphangiography to exclude recurrence. Based on the presented case series in which conservative and interventional therapy had failed, we gained important clinical experience in microsurgical treatment of central lymphatic lesions and provide a new treatment algorithm. Radiologic interventions such as recanalization or embolization of the pathology should be evaluated as standard treatment. In case of remaining chylous leaks, chylous reflux with lymphedema, stenosis, or protein-loosing enteropathy, LVA of the thoracic duct represents an innovative microsurgical therapy. Level of Evidence: Level V, therapeutic study.

Abstract Objective Emergent lung cancer screening programs increased detection of small pulmonary nodules. Anatomical resection in case of early-stage lung cancer with only one intervention becomes increasingly desirable. Current literature lacks procedure data about both diagnosis and subsequent indicated resection. After starting our hybrid operating room program, we reviewed the efficacy of detection, diagnosis and therapy in one-step. Methods Undiagnosed pulmonary nodules suspicious of lung cancer, which were not detectable by conventional video-assisted thoracoscopic surgery (VATS) due to localization and size, were scheduled for a hybrid procedure consisting of a cone-beam CT-guided hookwire insertion and C-arm assisted thoracoscopic wedge resection for frozen section. All procedures were analyzed for perioperative outcomes including success rate of image-guided nodule resection and rate of concomitant correct anatomical resection. Results Between July 2020 and July 2021, 23 patients with 25 nodules underwent image-guided VATS (iVATS) in the hybrid room. Twenty-two nodules were successfully marked by hookwire, three nodules were detected by ultrasound in one case and palpation in two cases. In 16 patients (70%) wedge resection with frozen section showed malignancy. Five patients with previous history of operated lung cancer received only a diagnostic wedge, as frozen section could not differentiate between primary or metastatic lung cancer. Eleven patients (48%) had early-stage primary lung cancer (8 adenocarcinoma, one typical carcinoid, one small-cell lung cancer and one squamous-cell lung cancer). Ten of them (91%) received a synchronous completion anatomical resection (seven lobectomies, three segmentectomies). In one patient, malignancy was only confirmed in final histology. Conclusion One-stop-shop diagnosis and treatment by iVATS with frozen section and concomitant completion anatomical resection in a hybrid operating room for otherwise non-well approachable early stage lung cancer is patient-convenient for the increasingly detected small pulmonary nodules.

Purpose: To investigate, by quantitative and qualitative enhancement measurements, the correlation between tumor enhancement on cone beam computed tomography (CBCT) images and treatment response at 6 months in patients undergoing transarterial radioembolization (TARE) for liver metastases. Materials and Methods: 36 patients (56% male; median age 62.5 years) with 104 metastases were retrospectively included. Quantitative and qualitative enhancement of liver metastases were evaluated on CBCT images before TARE. Quantitative analysis consisted of lesion enhancement measurements (ROI HU lesion – ROI HU relative to inferior vena cava). Qualitative analysis consisted of subjective enhancement pattern analysis (diffuse, sparse, rim-like or non-enhancing). Morphologic tumor response was evaluated according to RECIST 1.1 criteria on follow-up CT or MR imaging. Results: At a mean follow up of 6.5 ± 3.7 months, progressive disease (PD) was found in 4 patients, partial response (PR) in 11 and stable disease (SD) in 21. Relative lesion enhancement was significantly different between these groups (-37.5±154.2 HU vs. 103.8±93.4 vs. 181±144 HU in PD vs. SD vs. PR group, respectively; p<0.01). ROC analysis of relative lesion enhancement to predict progressive disease showed an area under the curve of 0.86 (p<0.01). For qualitative lesion enhancement analysis, no difference between groups was found. Conclusion: Quantitative enhancement measurements derived from intraprocedural contrast enhanced CBCT may identify responders to TARE in patients with liver metastases.

Purpose Abdominal aortic aneurysms (AAAs) affect the vascular perfusion of the lumbar spine. The treatment of AAAs with endovascular aortic aneurysm repair (EVAR) completely occludes the direct vascular supply to the lumbar spine. We hypothesized that patients with AAA who undergo EVAR show a different pattern of spinal degeneration than individuals without AAA. Methods In this retrospective institutional review board-approved study, 100 randomly selected patients with AAA who underwent EVAR with computed tomography (CT) scans between 2005 and 2017 were compared with age- and gender-matched controls without AAA. In addition, long-term follow-up CT images (> 6 months before EVAR, at the time of EVAR, and > 12 months after EVAR) of the patients were analysed to compare the progression of degeneration from before to after EVAR. Degeneration scores, lumbar levels with the most severe degeneration, and lumbar levels with progressive degeneration were analysed in all CT images. Fisher’s exact test, Wilcoxon signed-rank test, and Mann–Whitney U test were performed for statistical analyses. Results Compared with the control group ( n = 94), the most severe degeneration was more commonly detected in the mid-lumbar area in the patient group ( n = 100, p = 0.016), with significantly more endplate erosions being detected in the lumbar spine ( p = 0.015). However, EVAR did not result in significant additional acceleration of the degenerative process in the long-term follow-up analysis ( n = 51). Conclusion AAA is associated with atypical, more cranially located spinal degradation, particularly in the mid-lumbar segments; however, EVAR does not seem to additionally accelerate the degenerative process. This observation underlines the importance of disc and endplate vascularization in the pathomechanism of spinal degeneration. Level of evidence I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

The purpose of this study was to evaluate the feasibility of recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses with a transsplenic assisted patient-tailored approach with or without transjugular intrahepatic portosystemic shunt (TIPS) creation. In this retrospective study, 10 patients (median age, 48.4 years; interquartile range, 5.1 years) underwent revascularization between November 2016 and August 2020. Portal cavernoma was present in all patients, with complete splenic vein thrombosis in 70%. The technical success rate was 80%. Additional TIPS creation was performed in 5 (50%) patients. At a median follow-up of 19.3 months (interquartile range, 17.9 months), the primary and secondary patency rate was 70% and 100%, respectively. During follow-up, 1 patient died due to recurrent upper gastrointestinal variceal hemorrhage. In conclusion, percutaneous transsplenic assisted recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses is feasible. However, multiple access points may still be needed. Additional TIPS creation appears to be necessary only in case of insufficient portal venous flow into the liver.

PURPOSE:To investigate the potential of texture analysis and machine learning to predict treatment response to transarterial radioembolization (TARE) on pre-interventional cone-beam computed tomography (CBCT) images in patients with liver metastases.MATERIALS AND METHODS:In this IRB-approved retrospective single-center study 36 patients with a total of 104 liver metastases (56 % male, mean age 61.1 ± 13 years) underwent CBCT prior to TARE and follow-up imaging 6 months after therapy. Treatment response was evaluated according to RECIST version 1.1 and dichotomized into disease control (partial response/stable disease) versus disease progression (progressive disease). After target lesion segmentation, 104 radiomics features corresponding to seven different feature classes were extracted with the pyRadiomics package. After dimension reduction machine learning classifications were performed on a custom artificial neural network (ANN). Ten-fold cross validation on a previously unseen test data set was performed.RESULTS:The average administered cumulative activity from TARE was 1.6 Gbq (± 0.5 Gbq). At a mean follow-up of 5.9 ± 0.8 months disease control was achieved in 82 % of metastases. After dimension reduction, 15 of 104 (15 %) texture analysis features remained for further analysis. On a previously unseen set of liver metastases the Multilayer Perceptron ANN yielded a sensitivity of 94.2 %, specificity of 67.7 % and an area-under-the receiver operating characteristics curve of 0.85.CONCLUSION:Our study indicates that texture analysis-based machine learning may has potential to predict treatment response to TARE using pre-treatment CBCT images of patients with liver metastases with high accuracy.

Quantification of post-interventional adverse events of outpatient SIRT leading to hospitalization and quantification of radiation exposure. In this single-center, retrospective cohort study, we reviewed 212 patients treated with SIRT (90Y-microspheres) for primary and secondary liver malignancies. We searched for adverse events (AEs) and serious adverse events (SAEs), defined as AE’s causing hospitalization. Additionally, radiation exposure was measured in 36 patients. Seven patients had an SAE (3.3%), four patients had AE without readmission/hospitalization (1.9%) and 201 patients had no complications (94.8%). The mean ambient dose rate at 1 m distance from the source after administration of 90Y-microspheres was 1.88 µSv/h ± 0.74 (± SD) with a range from 4.3 to 0.2 µSv/h. Outpatient radioembolization with 90Y-microspheres is safe and requires hospitalization only in a very small number of patients. The mean dose rate was low and met the national conditions for outpatient treatment (< 5 µSv/h).