Purpose: To compare the safety and clinical outcomes of combined transjugular intrahepatic portosystemic shunt (TIPS) plus variceal obliteration to those of TIPS alone for the treatment of gastric varices (GVs). Materials and Methods:A single-center, retrospective study of 40 patients with bleeding or high-risk GVs between 2008 and 2019 was performed. The patients were treated with combined therapy (n ¼ 18) or TIPS alone (n ¼ 22). There were no significant differences in age, sex, model for end-stage liver disease score, or GV type between the groups. The primary outcomes were the rates of GV eradication and rebleeding. The secondary outcomes included portal hypertensive complications and hepatic encephalopathy. Results:The mean follow-up period was 15.4 months for the combined therapy group and 22.9 months for the TIPS group (P ¼ .32). After combined therapy, there was a higher rate of GV eradication (92% vs 47%, P ¼ .01) and a trend toward a lower rate of GV rebleeding (0% vs 23%, P ¼ .056). The estimated rebleeding rates were 0% versus 5% at 3 months, 0% versus 11% at 6 months, 0% versus 18% at 1 year, and 0% versus 38% at 2 years after combined therapy and TIPS, respectively (P ¼ .077). There was no difference in ascites (13% vs 11%, P ¼ .63), hepatic encephalopathy (47% vs 55%, P ¼ .44), or esophageal variceal bleeding (0% vs 0%, P > .999) after the procedure between the groups. Conclusions:The GV eradication rate is significantly higher after combined therapy, with no associated increase in portal hypertensive complications. This translates to a clinically meaningful trend toward a reduction in GV rebleeding. The value of a combined treatment strategy should be prospectively studied in a larger cohort to determine the optimal management of GVs. ABBREVIATIONSBATO ¼ balloon-occluded antegrade transvenous obliteration, BRTO ¼ balloon-occluded retrograde transvenous obliteration, EV ¼ esophageal varice, GV ¼ gastric varice, HE ¼ hepatic encephalopathy, PSG ¼ portosystemic pressure gradient, TIPS ¼ transjugular intrahepatic portosystemic shunt From the Department of Radiology (K.

Pulmonary embolism is a common cause of morbidity and mortality which continues to increase in overall incidence. Because it can occur with a wide range of clinical presentations, different guidelines have been developed for appropriate risk stratification of patients; interventional radiology plays a vital role in the management of both massive and submassive pulmonary embolism. Catheter-directed therapy, including mechanical and aspiration thrombectomy, standard catheter-directed thrombolysis, and ultrasound-accelerated thrombolysis, has many benefits, including lower thrombolytic doses and intraclot administration of thrombolytic therapy. While the role of catheter-directed therapy is still being developed, four important prospective studies have demonstrated its safety and efficacy. Additional studies comparing short- and long-term clinical outcomes in patients treated with catheter-directed therapy versus anticoagulation are the next step in understanding its role within the management of submassive pulmonary embolism. Furthermore, multidisciplinary pulmonary embolism response teams, in which interventional radiology plays a crucial role, are becoming essential to appropriately managing pulmonary embolism patients, including selection of those who may benefit from catheter-directed therapy.

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How I Do It 212This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.fluoroscopic anatomy, and to provide a case-based tutorial on the techniques and benefits of IVUS guidance.

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