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Purpose To determine predictors of survival after transarterial radioembolization of hepatic metastases from breast cancer. Materials and Methods Twenty-four patients with chemotherapy-refractory hepatic metastases from breast cancer who underwent radioembolization from 2013 to 2018 were evaluated based on various demographic and clinical factors before and after treatment. Overall survival (OS) was estimated by Kaplan–Meier method. Log-rank analysis was performed to determine predictors of prolonged OS from the time of first radioembolization and first hepatic metastasis diagnosis. Results Median OS times were 35.4 and 48.6 months from first radioembolization and time of hepatic metastasis diagnosis, respectively. Radioembolization within 6 months of hepatic metastasis diagnosis was a positive predictor of survival from first radioembolization, with median OS of 38.9 months vs 22.1 months for others (P = .033). Estrogen receptor (ER)–positive status predicted prolonged survival (38.6 months for ER+ vs 5.4 months for ER−; P = .005). The presence of abdominal pain predicted poor median OS: 12.8 months vs 38.6 months for others (P Conclusions In patients with metastatic breast cancer, radioembolization within 6 months of hepatic metastasis diagnosis and ER+ status appear to be positive predictors of prolonged survival. Conversely, baseline abdominal pain, baseline ascites, and treatment-related grade ≥ 2 toxicity at 3 months after treatment appear to be negative predictors of OS.

To test the hypothesis that percutaneous combined chemical and mechanical necrosectomy using a Malecot anchor drain and Arrow-Trerotola Percutaneous Thrombolytic device (PTD) in patients with walled-off pancreatic necrosis (WOPN) was feasible, safe, and efficacious compared with a control group undergoing mechanical necrosectomy alone.In a retrospective analysis, patients with WOPN not amenable to endoscopic-guided cystogastrostomy placement were studied as case and control groups. Patients in the case group underwent percutaneous combined chemical (hydrogen peroxide 3%) and mechanical necrosectomy using the Malecot anchor drain and/or Arrow-Trerotola PTD from December 2020 through April 2022. The controls underwent mechanical necrosectomy alone without chemical necrosectomy. Clinical success was defined as complete resolution of the cavity on follow up noncontract CT scans with subsequent drain removal.Thirteen patients in the case group and 11 control patients underwent percutaneous drain placement followed by percutaneous combined chemical and mechanical necrosectomy (case group) or mechanical necrosectomy only (control group) for WOPN. Drain placement and necrosectomy were technically successful in all studied patients. One case patient developed post-procedural sepsis due to communication between the cavity and the splenic vein. Another case patient developed bleeding from a branch of the pancreaticoduodenal artery on post-necrosectomy day 9, which was successfully embolized by interventional radiology. No pancreaticocutaneous fistula was reported on 3-month follow-up. The clinical success rate in the case and control groups was 100% and 38.4%, respectively (p=0.003).Percutaneous combined chemical and mechanical necrosectomy is a feasible, safe, and effective treatment of WOPN.

To identify differences in mortality or length of hospital stay for mothers treated with uterine artery embolization (UAE) or hysterectomy for severe postpartum hemorrhage (PPH), as well as to analyze whether geographic or clinical determinants affected the type of therapy received.This National Inpatient Sample study from 2005 to 2017 included all patients with live-birth deliveries. Severe PPH was defined as PPH that required transfusion, hysterectomy, or UAE. Propensity score weighting-adjusted demographic, maternal, and delivery risk factors were used to assess mortality and prolonged hospital stay.Of 9.8 million identified live births, PPH occurred in 31.0 per 1,000 cases. The most common intervention for PPH was transfusion (116.4 per 1,000 cases of PPH). Hysterectomy was used more frequently than UAE (20.4 vs 12.9 per 1,000 cases). The following factors predicted that hysterectomy would be used more commonly than UAE: previous cesarean delivery, breech fetal position, placenta previa, transient hypertension during pregnancy without pre-eclampsia, pre-existing hypertension without pre-eclampsia, pre-existing hypertension with pre-eclampsia, unspecified maternal hypertension, and gestational diabetes (all P.001). Delivery risk factors associated with greater utilization of hysterectomy over UAE included postterm pregnancy, premature rupture of membranes, cervical laceration, forceps vaginal delivery, and shock (all P.001). There was no difference in mortality between hysterectomy and UAE. After balancing demographic, maternal, and delivery risk factors, the odds of prolonged hospital stay were 0.38 times lower with UAE than hysterectomy (P.001).Despite similar mortality and shorter hospital stays, UAE is used far less than hysterectomy in the management of severe PPH.

Purpose Optional inferior vena cava filters (IVCFs) are associated with adverse events that have prompted an increased interest in improving filter retrieval rates. The aim of this study was to initiate an IVCF clinic and simultaneously increase retrieval rates by engaging and educating physicians to refer existing IVCFs for retrieval. Materials and Methods An IVCF clinic was established at a single institution in 2012 with a comprehensive database of prospectively acquired information for patients receiving IVCFs. Alongside the IVCF clinic initiation, a retrospective review was conducted on filter placement over the 8 pre-clinic months prior to the IVCF clinic. A separate database was created for these IVCFs and referring physicians were contacted to educate them on the IVCF clinic, IVCF types, indications, and coordinate for retrieval. The number of IVCFs referred for retrieval was recorded. Results A total of 146 IVCFs (27 permanent and 119 optional filter types) were implanted during the 8 pre-clinic months. Fourteen optional filters were referred for retrieval (11.7%) during the pre-clinic period resulting in 12 retrievals (10.0%). As patients were prospectively enrolled through the new IVCF clinic, referring physicians for the pre-clinic IVCFs were contacted to discuss retrieval and the new IVCF clinic. Of the remaining 105 optional IVCFs, 23 patients were deceased, 20 declared permanent, and 7 lost to follow-up. Twelve of 55 eligible patients (20%) were referred for retrieval resulting in an almost two fold increase in the initial pre-clinic referrals (p Conclusion The retrieval rate of optional IVCF at this institution was significantly increased by the retrospective review of previously placed filters during the pre-clinic period. Additionally, discussions with referring physicians allowed an opportunity to promote appropriate filter selection and discuss the aims of the IVCF clinic. Early coordinated efforts with referring physicians such as these may ultimately increase referrals for filter placement as well as improved retrieval rates.