BACKGROUND It is estimated that, in 2019, 73,820 new cases of kidney cancer will be diagnosed in the United States, resulting in 14,770 new deaths (1). Renal cell carcinoma (RCC) is the most common type of kidney cancer, accounting for approximately 9 out of 10 kidney cancers (2). Owing to the increasing use of cross-sectional imaging and improving life expectancies, the incidence rates of RCC have substantially increased in developed countries over the past 20 years (3). More than 50% of RCCs are detected incidentally on noninvasive imaging (4). Most of these incidentally detected masses are small and localized within the renal capsule. These small renal masses, measuring <4cm (stage T1a), account for 48%-66% of all RCCs (5). In contrast, metastatic RCC accounts for about 17% of all RCCs at diagnosis (6). For small (4 cm in diameter) renal tumors, treatment options have traditionally included active surveillance, radical nephrectomy (RN), and nephron-sparing partial nephrectomy (PN). Nephron-sparing therapies have become popular to preserve renal function, particularly since oncologic outcomes from PN are equal to those from RN, thus making PN widely accepted as the standard of care for the management of clinically localized RCC (7-12). However, many patients are not candidates for surgery. For these patients, percutaneous image-guided ablation (radiofrequency [RF] ablation), cryoablation, and microwave (MW) ablation are available as validated options for tumor control. These have been established as important management options and are recommended by multiple societal guidelines (Appendix A [available online on the article's Supplemental Material page at www.jvir.org]), both nationally and internationally. In this document, the Society of Interventional Radiology (SIR) states its position on the use of ablation for the management of RCC, with a focus on small renal masses, biopsy, and cases of oligometastatic disease. An Executive Summary of recommendations in this document may be found in Appendix B
Painful vertebral body compression fractures are prevalent in elderly patients. Two-thirds of patients will have spontaneous resolution of pain in 4 to 6 weeks and initial management is nonoperative with pain management and bracing. A focused history and exam can identify patients likely to benefit from vertebral body augmentation (e.g., vertebroplasty or kyphoplasty). Patients with persistent back pain and bone marrow edema on magnetic resonance imaging may benefit from injection of cement into the fractured vertebral body with either vertebroplasty or kyphoplasty. Patients most likely to benefit are those with severe pain refractory to nonoperative management who are offered intervention within 3 weeks. The procedure is usually performed as an outpatient with rare complications. Most patients report immediate, durable pain relief.
Primary constrained TIPS is a feasible modification to conventional TIPS with similar technical and clinical success rates. A trend towards a smaller reduction in the portosystemic gradient and need for revision was observed in the constrained group. Advances in knowledge: Primary constrained TIPS allows for greater stepwise control over shunt diameter and may represent an improved technique for patients at risk for hepatic encephalopathy.
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