Transradial access(TRA)for performing interventional diagnosis and treatment can reduce access site complications.However,TRA can still cause complications in the operated limb,including radial artery spasm,radial artery perforation,hemorrhage,hematoma,radial artery dissection,osteofascial compartment syndrome,nerve injury,pseudoaneurysm,arteriovenous fistula,and radial artery occlusion,among which radial artery spasm is the most commonly seen.At present,the clinical recognition,prevention and treatment of complications of surgical limbs are still insufficient.Therefore,this consensus aims to make a detailed introduction about the identification,prevention and nursing of nine major types of complications of the surgical limb in interventional diagnosis and treatment procedures via radial artery access,to propose 24 recommendations which may provide a reference for medical institutions in carrying out the nursing care for complications of the surgical limb in interventional diagnosis and treatment procedures via radial artery access,and to reduce the occurrence of complications in patients.(J Intervent Radiol,2024,33:465-471)

Objective To explore the morphological symmetry of the anterior circulation cerebral arteries based on digital subtraction angiography(DSA),and to analyze the value of arterial walking route on the healthy side in guiding catheterization in endovascular treatment for patients with sick-side major artery occlusion of the anterior circulation.Methods A total of 250 consecutive patients who underwent cerebral angiography at the Shengli Oilfield Central Hospital of China between January 2021 and August 2022 were enrolled in this study as angiography group,which was subdivided into youth angiography subgroup(＜50 years),middle-aged angiography subgroup(50-69 years),and elderly angiography subgroup(≥70 years).Other 170 patients with acute occlusion of the anterior circulation vessels,who received emergency mechanical thrombectomy,were collected as thrombectomy group.After successful recanalization,the cerebral angiographic imaging findings of both groups,including the arterial walking route symmetry of bilateral C1 segment,C2-C3 segment,ophthalmic segment,M1 segment proximal to the bifurcation,and M1 segment distal to the bifurcation,were analyzed and compared between the two groups.The recanalization rate and the consistency of bilateral arterial walking route in the thrombectomy group were also analyzed.Results No statistically significant differences in the arterial walking route of the C1 segment,C2-C3 segment,ophthalmic segment,M1 segment proximal to the bifurcation,and M1 segment distal to the bifurcation existed between the left side and right side(all P＞0.05).Ordinary bilateral symmetry was observed in M1 segment proximal to the bifurcation,and excellent bilateral symmetry was observed in all the other segments.There were no statistically significant differences in the bilateral arterial walking route of the C1 segment,C2-C3 segment,ophthalmic segment,M1 segment proximal to the bifurcation,and M1 segment distal to the bifurcation between each other among the three subgroups(all P＞0.05).Ordinary bilateral symmetry of the C1 segment was observed in the youth angiography subgroup,ordinary bilateral symmetry of the M1 segment proximal to the bifurcation was observed in all three subgroups,and excellent bilateral symmetry was observed in all the other segments.In the thrombectomy group the recanalization rate was 95.5％and the consistency rate of bilateral arterial walking route was 89.0％.Conclusion Bilateral symmetry exists in the C1 segment,C2-C3 segment,ophthalmic segment,M1 segment proximal to the bifurcation,and M1 segment distal to the bifurcation of the anterior circulation cerebral arteries.These findings provide a reliable basis of referring healthy-side arterial walking route to guide catheterization in endovascular treatment for mechanical thrombectomy and recanalization of sick-side major artery occlusion of the anterior circulation.(J Intervent Radiol,2024,33:472-478)

Objective To discuss the clinical value of echocardiographic indicators in assessing the short-term efficacy of transcatheter aortic valve replacement(TAVR)and surgical aortic valve replacement(SAVR)in treating patients with severe aortic valve stenosis(AS).Methods The clinical data of 70 patients with severe AS,who received treatment at the Daping Hospital of Army Military Medical University of China between June 2019 and September 2022 were retrospectively analyzed.The patients were divided into SAVR group(n=40)and TAVR group(n=30).The preoperative one-week and postoperative one-month echocardiographic indicators were compared between the two groups.Results In both groups,the postoperative one-month peak aortic valve velocity(Vmax),aortic valve mean transvalvular pressure gradient(mPG),relative thickness of chamber wall(RWT),and left ventricular mass index(LVMI)were decreased when compared with preoperative values(all P＜0.05);in TAVR group the left ventricular ejection fraction(LVEF),LVMI and incidence of perivalvular leakage were remarkably higher than those in SAVR group,while the Vmax and mPG were obviously lower than those in SAVR group(all P＜0.05).In TAVR group,the mitral regurgitation decreased from preoperative 12 patients(40％)to postoperative 2 patients(6.7％)and the over-moderate tricuspid regurgitation decreased from preoperative 7 patients(23.3％)to postoperative one patient(3.3％)(all P＜0.05).In SAVR group,the mitral regurgitation decreased from preoperative 15 patients(37.5％)to postoperative 2 patients(5.0％)and the over-moderate tricuspid regurgitation decreased from preoperative 9 patients(22.5％)to postoperative one patient(2.5％)(all P＜0.05).The pulmonary artery hypertension in TAVR group decreased from preoperative 17 patients(56.7％)to postoperative 4 patients(13.3％),which in SAVR group decreased from preoperative 22 patients(55.0％)to postoperative 5 patients(12.5％)(P＜0.05),but the differences in the above indexes between the two groups were not statistically significant(all P＞0.05).Conclusion TAVR and SAVR have similar efficacy in improving secondary valve regurgitation and pulmonary artery hypertension caused by severe AS.TAVR is superior to SAVR in improving postoperative ventricular reverse remodeling and hemodynamics,although the incidence of paravalvular leakage in TAVR is higher than that in SAVR.(J Intervent Radiol,2024,33:479-482)

Objective To compare the therapeutic effect of lauromacrogol combined with different concentrations of pingyangmycin in the treatment of low-flow venous malformations of limbs.Methods A total of 83 child patients with low-flow venous malformations of limb,who were admitted to the Xi'an Thoracic Surgery/Tumor(Hemangioma)Intervention Center of China between 1 January 2021 and 1 June 2022,were enrolled in this study.The child patients were randomly divided into group A(n=42)and group B(n=41).Under imaging guidance,lauromacrogol mixed together with pingyangmycin(2 mg/mL in group A,and 1 mg/mL in group B)was slowly injected into the cavity of venous malformations until the drug mixture filled the tumor cavity.The curative effect,number of treatments within 6 months,and the incidence of adverse reactions were compared between the two groups.Results Successful interventional sclerotherapy was accomplished in all the 83 child patients of both groups.During the follow-up period of 6 months,the effective rate in group A and group B was 92.9％(39/42)and 87.8％(36/41)respectively.A total of 88 interventional procedures were performed in group A and 137 interventional procedures in group B,the difference between the two groups was statistically significant(x2=3.282,P=0.047).Adverse reactions occurred in 10 child patients of group A and in 8 child patients of group B,the difference between the two groups was not statistically significant(P=0.709).Conclusion In treating low-flow venous malformations of limbs,the use of higher concentration pingyangmycin and lauromacrogol mixture has quite the same curative effect and incidence of adverse effects as the use of lower concentration pingyangmycin and lauromacrogol mixture,although the use of higher concentration pingyangmycin and lauromacrogol mixture can reduce the number of treatments in child patients.(J Intervent Radiol,2024,33:483-487)

Objective By comparison with the surgical resection,to evaluate the relapse-free survival(RFS),overall survival(OS),and clinical safety of transcatheter hepatic arterial chemoembolization(TACE)combined with microwave ablation(MWA)in the treatment of early primary hepatocellular carcinoma(HCC).Methods From January 2013 to January 2018 at authors'hospital,51 HCC patients received TACE combined with MWA(TACE+MWA group)and 58 HCC patients received surgical resection(RES group).The HCC lesions were single tumor with diameter ≤7 cm or multiple tumors with stage Ⅰ a-Ⅱ a meeting the"up-to-7"criteria.The postoperative RFS,OS,and clinical safety were compared between the two groups.Results The one-,3-and 5-year RFS in the TACE+MWA group were 84.3％,37.3％and 13.7％respectively,which in the RES group were 67.2％,27.6％and 13.8％respectively.The difference in the one-year RFS between the two groups was statistically significant(P=0.039),and the differences in the 3-and 5-year RFS between the two groups were not statistically significant(P=0.281 and P=0.992,respectively).The one-,3-and 5-year survival rates in the TACE+MWA group were 98％,62.7％and 45.1％respectively,which in the RES group were 94.8％,75.9％and 44.8％respectively,and the differences between the two groups were not statistically significant(P=0.704,P=0.137 and P=0.977 respectively).No treatment-related death occurred in both groups.In the TACE+MWA group,the main complications included transient embolism syndrome,abdominal pain during ablation procedure,and mild to moderate transient elevation of transaminase after treatment.In the RES group,the main postoperative complications included fever,pleural effusion,abdominal effusion,and intraoperative bleeding;and in one patient the postoperative liver function impairment worsened to Child grade C.The average cost of hospitalization in the TACE+MWA group was(39 834.98±6 717.38)Chinese yuan,which in the RES group was(49 042.59±11 810.69)Chinese yuan,the difference between the two groups was statistically significant(P=0.017).The hospitalization length in the TACE+MWA group was 23 days(19-28 days),which in the RES group was 21 days(17-25 days),and the difference between the two groups was not statistically significant(P=0.196).Conclusion For the treatment of early HCC,TACE combined with MWA has reliable curative effect,and also has the advantages of being safe and economical.Therefore,this therapy can be used as a preferred option of non-surgical treatment for single tumor with ≤7 cm diameter or multiple tumors with stage Ⅰ a-Ⅱa meeting"up-to-7"criteria.(J Intervent Radiol,2024,33:488-494)

Objective To investigate the feasibility,safety,and effectiveness of ultrasound-guided microwave ablation in the treatment of multifocal T1N0M0 papillary thyroid carcinoma(PTC).Methods A total of 68 patients with multifocal T1N0M0(≤ 3 lesions)PTC,whose diagnosis was confirmed at authors'hospital from January 2019 to January 2022,were randomly included as the study subjects.The maximum diameter of tumor was ≤2 cm.Ultrasound-guided microwave ablation was carried out in all patients.The patients were followed up until April 2023,with a median time of 30 months.The follow-up examinations included conventional ultrasound,contrast-enhanced ultrasound,thyroid function,and necessary fine needle aspiration cytology(FNA).Results The 68 patients were divided into T1a group(n=52)and T1b group(n=16).The ablation time in Tib group was significantly longer than that in T1a group,and the maximum diameter of tumor in T1b group was significantly larger than that in T1a group,the differences were statistically significant(P＜0.05).All 68 patients successfully completed the surgery and were recovered at discharge with no obvious complications.Contrast-enhanced ultrasound imaging revealed that the ablated lymph nodes showed no enhancement.Post-ablation one-,3-and 6-month maximum diameters and volumes of the tumor were significantly larger than their pre-ablation values(P＜0.05).Post-ablation 12-,18-and 24-month maximum diameters and volumes of the tumor were gradually decreased(P＜0.05).No tumor progression or recurrence was observed during follow-up period.Thyroid function including thyroglobulin,total thyroxine,and thyrotropin,which were determined before ablation and at the last follow-up visit,showed no significant changes(P＞0.05).Conclusion For the treatment of T1N0M0 PTC,ultrasound-guided microwave ablation has excellent clinical feasibility,safety,and effectiveness.(J Intervent Radiol,2024,33:495-499)

Objective To investigate the influencing factors associated with bleeding complications in patients with obstructive jaundice treated with percutaneous transhepatic cholangial drainage(PTCD).Methods Clinical data of 1 042 patients with obstructive jaundice,who received PTCD at the Affiliated Hospital of Guizhou Medical University,the Xiangya Second Hospital of Central South University,and the Affiliated Cancer Hospital of Guizhou Medical University of China between January 2015 and January 2021,were collected.The risk factors related to PTCD bleeding complications were retrospective analyzed.Results The location where the drainage tube forming loop had a statistically significant effect on PTCD bleeding complications(P＜0.01).Compared with the loop-forming within the common bile duct,the loop-forming within the left and right hepatic duct would increase the risk of postoperative bleeding by 155.6％(OR=2.556,95％CI:1.251-5.225),the loop-forming within the lower order branch of the left and right hepatic duct would increase the risk of postoperative bleeding by 414.4％(OR=5.144,95％CI:2.618-10.106).The difference in the risk degree of postoperative bleeding between different drainage ways after successful puncturing was statistically significant(P＜0.05).Compared with the external drainage method,internal-external joint drainage method would increase the risk degree of postoperative bleeding by 159.1％(OR=2.591,95％CI:1.102-6.091).Preoperative platelet count and preoperative total bilirubin level were the independent risk factors for bleeding complications of PTCD(P＜0.05).For each unit increase in preoperative platelet count,the probability of developing postoperative bleeding complications would decrease by 0.2％(OR=0.998,95％CI:0.995-1.000),and a preoperative platelet count level＜228 ×109/L would have an impact on the postoperative bleeding.For each unit increase in preoperative total bilirubin,the probability of developing postoperative bleeding complications would increase by 0.3％(OR=1.003,95％CI:1.001-1.004),and a preoperative total bilirubin＞264.4 μmol/L would have an impact on the postoperative bleeding.Conclusion The loop-forming location of draining tube and the drainage method are the independent risk factors for PTCD bleeding complications.The closer the loop-forming location to the tertiary branches is,the greater the risk of bleeding would be.The bleeding risk of internal-external joint drainage method is higher than that of external drainage method.The preoperative total bilirubin and preoperative platelet count are the independent risk factors for bleeding complications of PTCD.The preoperative total bilirubin level is positively correlated with bleeding risk,while the preoperative platelet count level is negatively correlated with the bleeding risk.(J Intervent Radiol,2024,33:500-506)

Objective To evaluate the application value of percutaneous angle positioning system based on augmented reality in improving the accuracy of liver puncture.Methods A canine liver with an embedded marking ring was used as the target for puncture.A skilled physician with over 5 years of experience in liver puncture and a novice physician with limited experience in liver puncture separately performed liver puncture using either the augmented reality-based percutaneous angle localization system(navigation)or CT-guided technique alone(non-navigation).The corresponding puncturing data of non-navigation skilled group(Group A),non-navigation non-skilled group(Group B),navigation skilled group(Group C),and navigation non-skilled group(Group D)were obtained.The differences in the evaluation indicators,including the number of CT scans,number of needle adjustment,time spent for operation,and distance of error,between Group A and Group B,between Group C and Group D,between Group A and Group C,and between Group B and Group D,were analyzed.Results Statistically significant differences in the number of CT scans,number of needle adjustment,time spent for operation,and distance of error existed between Group A and Group B,between Group A and Group C,and between Group B and Group D(all P＜0.0 5),while the differences in the number of CT scans,number of needle adjustment,time spent for operation,and distance of error between Group C and Group D were not statistically significant(all P＞0.05)Conclusion In performing liver puncture,the use of percutaneous angle localization system can reduce the number of CT scans,number of needle adjustment,time spent for operation and distance of error,and improve the puncture accuracy as well,which provides a basis for the clinical utilization of this system and the employment of this system-guided puncture technology in primary hospitals.(J Intervent Radiol,2024,33:507-511)

Objective To evaluate the clinical efficacy and safety of transcatheter arterial infusion with gemcitabine and nab-paclitaxel(GN)as first-line therapy in treating patients with advanced pancreatic cancer.Methods The clinical data of a total of 50 patients with advanced pancreatic cancer,who were treated with transcatheter arterial infusion chemotherapy with GN regimen at the Zhejiang Cancer Hospital of China between January 2016 and December2020,were collected The objective effective rate(ORR),progression-free survival(PFS),overall survival(OS)and treatment-related toxic reactions were analyzed.Results A total of 236 times of transcatheter arterial infusion chemotherapy were carried out in the 50 patients,with an average perfusion procedure of 4.72 times per patient.Complete remission(CR)was obtained in 0 patient,partial remission(PR)in 16 patients,and stable disease(SD)in 21 patients.The ORR was 32％,the median PFSwas5.1 months,and the OS was 9.8 months.The main adverse events included neutropenia,thrombocytopenia,vomiting,nausea,fatigue,etc.Conclusion For patients with advanced pancreatic cancer,transcatheter arterial infusion chemotherapy with GN regimen carries good short-term efficacy and safety,it can improve patient's PFS and OS to a certain extent.(J Intervent Radiol,2024,33:512-515)

Objective To explore the biliary tract microbiota changes before and after drainage treatment in patients with malignant biliary obstruction(MBO),and to study the effects of biliary obstruction and drainage intervention on the bile microbiota from a microecological point of view.Methods From January 2020 to December 2022,DSA-guided percutaneous transhepatic catheter drainage(PTCD)was carried out in 32 patients with MBO.A 22G drainage needle was inserted into the bile duct,and about 15-20mL of bile was extracted after it was confirmed that the needle was located within the intrahepatic bile duct,then,an external drainage tube,or an internal drainage tube together with an external drainage tube,was implanted into the bile duct along the guide wire.Seven days after PTCD,bile was extracted through a drainage tube.Bile sampling for germiculture and gene sequencing was conducted twice.The general data of patients,including whether acute cholangitis occurred and its severity,whether antibiotics was used for treatment,etc.,were collected.Results Of the 32 patients,cholangiocarcinoma was seen in 15,pancreatic cancer in 10,hepatocellular carcinoma in 3,and hilar lymph node metastasis from gastrointestinal malignant tumor in 4.Before PTCD,in the bile microbiota the burkholderia,acinetobacter,pseudomonas and staphylococcus were the bacteria with a high relative abundance,and the diversity and evenness of other microbial species seen in the normal biliary tract were reduced.Conclusion There is a stable microbiota within the normal biliary system,and in malignant obstructive biliary tract the microbiota has similar composition.After biliary drainage,the abundance of intestinal flora in bile is increased,and the species richness and diversity of the original biliary tract microbial community are decreased,which may explain the clinical phenomenon that patients are more prone to biliary tract infection after biliary drainage.(J Intervent Radiol,2024,33:516-522)