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Based on patient and tumor characteristics, some authors favor laparoscopic microwave ablation (LMWA) over the percutaneous approach (PMWA) for treatment of hepatocellular carcinoma (HCC). We compared the two techniques in terms of technique efficacy, local tumor progression (LTP) and complication rates. A retrospective comparative analysis was performed on 91 consecutive patients (102 HCC tumors) who underwent PMWA or LMWA between October 2014 and May 2019. Technique efficacy at one-month and LTP at follow-up were assessed by contrast-enhanced CT/MRI. Kaplan–Meier estimates and Cox regression were used to compare LTP-free survival (LTPFS). At baseline analysis, LMWA group showed higher frequency of multinodular disease (p <.001) and average higher energy delivered over tumor size (p =.033); PMWA group showed higher rates of non-treatment-naïve patients (p =.001), patients with Hepatitis-C (p =.03) and BCLC-A1 disease (p =.006). Technique efficacy was not significantly different between the two groups (p =.18). Among effectively treated patients, 75 (83 tumors) satisfied ≥6 months follow-up, 54 (57 tumors) undergoing PMWA and 21 (26 tumors) LMWA. LTP occurred in 14/83 cases (16.9%): 12 after PMWA (21.1%) and 2 after LMWA (7.7%). At univariate analysis, technique did not correlate to LTPFS (p =.28). Subgroup analysis showed a trend toward worse LTPFS after PMWA of subcapsular tumors (p =.16). Major complications were observed in six patients (6.6%), 2 after PMWA and 4 after LMWA (3.2% vs 14.3%, p =.049). Technical approach did not affect LTPFS. Complications were reported more frequently after LMWA. Despite higher complication rates, LMWA seems a valid option for treatment of subcapsular tumors. [ABSTRACT FROM AUTHOR]

In the Canton of Ticino in southern Switzerland data from the monitoring programme for black grouse from 1981 to 2016 (population density, lek size, sex ratio in chicks and adults) were analysed together with information on bag statistics and hunting regulations to evaluate if mortality from hunting had an additive effect. In the study population the proportion of cocks at the beginning of the study period was only 23%. As hunting regulations for black grouse were tightened in the late 1970s the observed proportion of males showed an increase in particular during the first years but remained much lower than what would be expected from the sex ratio among chicks assuming equal survival between the sexes. The observed low proportion of adult males indicates a lower survival rate and as a consequence a smaller than natural lek size. High reproductive success two years before had a positive effect on lek size. The correlation coefficient between hunting bag and population size index increased with increasing hunting pressure and showed a decline over the years. Bag size in the period with a high hunting pressure (1981-1999, many hunting days) was driven by population density whereas in the second period (2000-2016, few hunting days) it was driven by hunting regulations. Our analysis showed that hunting affects population structure and presents indirect evidence that mortality due to hunting is additive. The study also shows that hunting management has to be continuously adapted to changes in the size and structure of the population as well as changes in habitat conditions. It is therefore essential to continue long-term monitoring of population size and of demographic parameters. [ABSTRACT FROM AUTHOR]

Purpose: Endovascular repair of true visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs) with stent-grafting (SG) can simultaneously allow aneurysm exclusion and vessel preservation, minimizing the risk of ischemic complications. Our aim was to report a single-center experience on SG of visceral aneurysms, focusing on technical aspects, clinical outcome and mid-term patency.Materials and Methods: Consecutive patients affected by VAAs-VAPAs and submitted to endovascular treatment were retrospectively reviewed, and SG cases with the self-expandable peripheral Viabahn stent-graft were analyzed (2003-2017). Aneurysm type, patient number, SG clinical setting, procedural data, peri-procedural complications, technical success, 30-day clinical success, 30-day mortality and follow-up period (aneurysm exclusion, stent-graft patency, ischemic complications) were analyzed.Results: SG was performed in 40 patients (24 VAPAs/16 VAAs) and in 44 procedures (25 in emergency, 19 in elective treatments), via transfemoral in 37 cases (transaxillary in 7 cases). One peri-procedural complication was recorded (a splenic artery dissection successfully converted to transcatheter embolization). The overall technical and clinical success rates were, respectively, 96 and 84%, with excellent trend in elective treatments (both 100%). Overall 30-day mortality was 12.5% (septic shock after pancreatic surgery). Stent-graft thrombosis occurred in 2 patients within 3 months, with aneurysm exclusion and without ischemic complications. Stent-graft patency and aneurysm exclusion were confirmed at 6, 12 and 36 months in 18, 12 and 7 patients, respectively.Conclusion: SG of VAAs and VAPAs was safe and effective, particularly in elective treatments. The Viabahn stent-graft, flexible and without shape memory, is suitable for endovascular repair of tortuous visceral arteries. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively report a large single-center experience of visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs) treated with covered stenting (CS) as the first therapeutic option vs transcatheter embolization (TE).Methods: One hundred patients (mean age 59±14 years; 58 men) underwent 59 elective and 41 emergent endovascular procedures to treat 51 VAAs and 49 VAPAs. Seventy patients had TE and 30 received CS (27 Viabahn and 3 coronary stent grafts). Both TE and CS were performed in 10 cases.Results: Technical success was 96% (97% CS, 96% TE), and 30-day clinical success was 83% (87% CS, 81.4% TE). Four major complications occurred; 30-day mortality was 7%, mainly due to septic shock following pancreatic surgery. The midterm follow-up was 20.8 months in the total population and 32.8 months in the CS group. More than 6 months after CS all aneurysms remained excluded; stent patency was achieved in 88%. Twelve CS patients with >3 years' follow-up had maintained stent patency.Conclusion: In endovascular treatment of visceral aneurysms, covered stenting was feasible in 30%. CS showed a slightly better efficacy than TE and good midterm patency. The Viabahn covered stent seems to be suitable for endovascular repair of tortuous visceral arteries affected by true or false aneurysms. [ABSTRACT FROM AUTHOR]

Interventional techniques vary: transcatheter embolization with coils is the most widely adopted endovascular option [2], and ultrasound (US)-guided compression or thrombin injection [3] are percutaneous alternatives. Contrast-enhanced computed tomography (CT) revealed a 1.5-cm IEAPA along the stainless steel wire used for retention suture (Fig 1a). Efficacy and safety of ultrasound guided percutaneous glue embolization in iatrogenic haemorrhagic complications of paracentesis and thoracocentesis in cirrhotic patients. [Extracted from the article]