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Background Advanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radiological criteria (NIRC) defined by the European Association for the Study of the Liver or the American Association for the Study of Liver Diseases. In 2017, The National Institute for Clinical Excellence mandated histological confirmation of disease to authorise the use of sorafenib in the UK. Methods This was a prospective multicentre audit in which patients suitable for sorafenib were identified at multidisciplinary meetings. The primary analysis cohort (PAC) was defined by the presence of Child-Pugh class A liver disease and performance status 0–2. Clinical, radiological and histological data were reported locally and collected on a standardised case report form. Results Eleven centres reported 418 cases, of which 361 comprised the PAC. Overall, 76% had chronic liver disease and 66% were cirrhotic. The diagnostic imaging was computed tomography in 71%, magnetic resonance imaging in 27% and 2% had both. Pre-existing histology was available in 45 patients and 270 underwent a new biopsy, which confirmed HCC in 93.4%. Alternative histological diagnoses included cholangiocarcinoma (CC) and combined HCC-CC. In cirrhotic patients, NIRC criteria had a sensitivity of 65.4% and a positive predictive value of 91.4% to detect HCC. Two patients (0.7%) experienced mild post-biopsy bleeding. Conclusion The diagnostic biopsy is safe and feasible for most patients eligible for systemic therapy

Context Prostatic artery embolization (PAE) has been established as a safe and effective treatment option for symptomatic benign prostatic hyperplasia (BPH). Thorough knowledge of detailed prostatic artery (PA) anatomy is essential. Aims The aim of this study was to provide a pictorial review of PA anatomy and prevalence of related anatomical variants, in addition to other anatomical and radiation dose considerations. Settings and Design Case series and review of literature. Materials and Methods We performed PAE for 210 patients from November 2015 to November 2020 under local anesthesia only. Anatomy, procedure duration, fluoroscopy time, radiation dose, technical success, and complications were analyzed. Statistical Analysis Used Descriptive statistics were analyzed using Microsoft Excel software. Results A total of 210 patients (420 sides) were analyzed. Double arterial supply on the same side was noted in 12 patients (5.7%). In 10 patients (4.7%), only a unilateral PA was identified. In two patients (0.9%), no PA could be identified. Frequencies of PA origins were calculated. Penile, rectal, and vesical anastomoses were identified with 79 (18.8%), 54 (12.9%), and 41 (9.8%) of PAs, respectively. Median skin radiation dose, procedure time, and fluoroscopy time were 505 mGy, 73 and 38 minutes, respectively. Complications occurred in nine patients (4.3%), none of them was major. Conclusions Knowledge of PA anatomy is essential when treating BPH by PAE for optimum results. There is no enough evidence to support routine use of preoperative computed tomography angiography and intraoperative cone-beam computed tomography as means of improving safety or efficacy.

Background: Large hepatic artery aneurysms are rare, especially spontaneous ones without history of hepatopancreatobiliary surgery or trauma. They are serious and need attention due to risk of spontaneous rupture. Management depends on local expertise with endovascular management being the preferred option, and surgical repair usually reserved to ruptured aneurysms in hemodynamically unstable patients. Methods: A 54-year-old female patient was referred to our hospital for treatment of incidentally discovered large hepatic artery aneurysm without obvious etiology. The decision was made to attempt percutaneous endovascular management at the interventional radiology unit. Result: The aneurysm sac was successfully excluded using covered stents. This was complicated by right hepatic artery occlusion and clinically insignificant contrast extravasation. These complications did not have any clinical sequel in terms of hemodynamic stability or impaired liver function. The patient was safely discharged few days after the procedure. Conclusion: Endovascular management of spontaneous large hepatic artery aneurysms is effective. Potential complications include hepatic artery occlusion and dissection, which may or may not have serious clinical consequences. This offers a less invasive treatment option compared to surgery.

Prostate artery embolization (PAE) is a minimally invasive, safe, and effective treatment for benign prostatic hyperplasia. PAE can often be technically challenging due to atherosclerosis and tortuous anatomy, leading to failure of catheterizing one side of prostatic supply, resulting in unilateral PAE, which markedly reduces clinical success. Major anastomosis between both prostatic halves can be exploited for embolizing the entire prostate from a unilateral approach when one side cannot be catheterized. If this anastomosis is extensive enough, clinical success is assumed to be equivalent to bilateral PAE. There is a limited number of published cases in this regard; our case report shows how to detect and exploit this anastomosis.