Hemodialysis access dysfunction causes increased morbidity and mortality rate which affects the quality of life in patients undergoing hemodialysis. The most common cause of hemodialysis dysfunction is dialysis-related stenosis which may progress to access thrombosis. 1,2 The most common sites of stenosis of dialysis graft and fistula are venous anastomosis and juxta-anastomosis, respectively.The key treatment for hemodialysis access stenosis is the correction of underlying stenosis and maintenance of function as long as possible. Endovascular treatment of hemodialysis stenosis is a minimally invasive procedure with an effective outcome. 3 Transluminal conventional balloon angioplasty (CBA) is treatment of choice for hemodialysis-related stenosis. The outcome in terms of average cumulative patency rate at 6 and 12 months are 21%-61% and 17%-42%, respectively. 4,5 Recently, paclitaxel-coated balloon angioplasty (PCBA) is an advance technique that proved to prolong the patency rate of dialysis circuit. 6,7 However, this technique cannot be used in all cases, particularly in the case of immediate recoil stenosis.Currently, stenting is more commonly used in hemodialysis access. According to the Society of Interventional Radiology guideline, 3 indication of stenting in hemodialysis access includes failure balloon angioplasty and twice recurrent stenosis within 3 months after a previous angioplasty. In addition, venous rupture that cannot be controlled by low-pressure balloon tamponade and access pseudoaneurysm should be treated by stent graft. 3 The average primary patency rates of bare metal stent or stent graft in hemodialysis access stenosis at 6 and 12 months are 44%-73% and 21%-54%, respectively. [8][9][10] Although, the primary patency rate of stenting was higher than that of the CBA; however, this technique

Background Endovascular treatment is a first-line treatment for upper thoracic central vein obstruction (CVO). Few studies using bare venous stents (BVS) in CVO have been conducted. Purpose To evaluate the treatment performance of upper thoracic central vein stenosis between BVS and conventional bare stent (CBS) in hemodialysis patients. Methods Hemodialysis patients with upper thoracic central vein obstruction who underwent endovascular treatment at the interventional unit of our institution from 1 January 2008 to 31 December 2018 were enrolled in the present study. CBS was used to treat central vein obstruction in 43 patients and BVS in 34 patients. We compared the primary patency rates and complications between the two stent types. P values < 0.05 were considered statistically significant. Results The patient demographic data between the CBS and BVS groups were similar. The characteristics of the lesions, procedures, and complications were not significantly different between the two groups ( P > 0.05). There were no statistically significant differences of primary patency rates at three and six months between the BVS and CBS groups (94.1% vs. 86.0% and 73.5% vs. 58.1%, respectively; P > 0.05). The primary patency rate at 12 months in the BVS group was significantly higher than that in the CBS group (61.8% vs. 32.6%; P = 0.008). Conclusion Endovascular treatment of central vein obstruction with BVS provided a higher primary patency rate at 12 months than CBS.

Purpose: To evaluate the safety and diagnostic performance of pulmonary nodule biopsies using cone-beam computed tomography (CBCT) guidance compared with conventional CT (CCT) guidance. Material and methods: Patients who had pulmonary nodules and underwent a transthoracic needle biopsy at the interventional unit from January 1, 2013 to June 30, 2018 were enrolled. CBCT with XperGuide software was used to biopsy 100 nodules, and CCT guidance was used to biopsy 266 nodules. The two techniques were compared in terms of radiation exposure, complications, and diagnostic accuracy. The p values of less than 0.05 were considered statistically significant. Results: The characteristics of the nodules were similar between CBCT and CCT guidance. The median radiation doses were not significantly different between the two groups (5.6 mGy vs. 5.4 mGy; p = 0.78). All minor, major, and overall complications were insignificant (25% vs. 24.4%, 3% vs. 4.9% and 28% vs. 29.3%, respectively). Although CBCT guidance showed higher sensitivity and accuracy than CCT guidance (93.3% vs. 84.1% and 95.0% vs. 89.9%), both techniques had similar specificity (100% vs. 100%) in the diagnosis of malignancy. Conclusions: CBCT guidance in pulmonary nodule biopsy provided higher diagnostic sensitivity and accuracy than CCT guidance. However, the complication rates and effective radiation doses did not differ between both techniques.

Hepatic vein aneurysm is an extremely rare case. The etiology of hepatic vein aneurysms is uncertain, and endovascular treatment of this condition has not been reported. We report the case of a 71-year-old woman with right upper abdominal pain who was diagnosed with hepatic vein aneurysm and was successfully treated with an endovascular technique.

INTRODUCTION: Patients with unresectable hepatocellular carcinoma treated with conventional transarterial chemoembolization (cTACE) have heterogeneous tumor burden and liver function. Therefore, the selection of patients for repeated cTACE is challenging owing to different outcomes. This study aimed to establish a decision-making scoring system for repeated cTACE to guide further treatment. METHODS: All patients with hepatocellular carcinoma who underwent cTACE between 2008 and 2019 were included and randomly assigned into training (n = 324) and validation (n = 162) cohorts. Tumor Size, number of Masses, Albumin-bilirubin score, baseline Alpha-fetoprotein level, and Response to initial cTACE session were selected to generate a “SMAART” score in the training cohort. Patients were stratified according to the SMAART score: low risk, 0–2; medium risk, 3–4; and high risk, 5–8. Prediction error curves based on the integrated Brier score and the Harrell C-index validated the SMAART scores and compared them with the Assessment for Retreatment with Transarterial chemoembolization (ART) score. RESULTS: The low-risk group had the longest median overall survival of 39.0 months, followed by the medium-risk and high-risk groups of 21.2 months and 10.5 months, respectively, with significant differences (P < 0.001). The validation cohort had similar results. The high-risk group had 63.1% TACE refractory cases. The Harrell C-indexes were 0.562 and 0.665 and the integrated Brier scores were 0.176 and 0.154 for ART and SMAART scores, respectively. DISCUSSION: The SMAART score can aid clinicians in selecting appropriate candidates for subsequent cTACE. A SMAART score of ≥5 after the first cTACE session identified patients with poor prognosis who may not benefit from additional cTACE sessions.