A systematic review of automated feeder detection software for locoregional treatment of hepatic tumors.

PURPOSE: The purpose of this study was to perform a systematic review of current literature describing the efficacy and technical outcomes of transarterial liver therapies using automated feeder detection (AFD) software. MATERIALS AND METHODS: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A structured search was performed in the PubMed, SCOPUS, and Embase databases of patients undergoing locoregional therapy of liver tumors utilizing AFD software. Demographic data, procedure data (including radiometrics) and tumor response rate were recorded. Where available, performance of AFD was compared to conventional digital subtraction angiography (DSA) and cone-beam CT (CBCT) without AFD. RESULTS: A total of 14 full-text manuscripts met inclusion criteria, comprising 1042 tumors in 604 patients (305 men, 156 women; mean age, 68.6±6.0 [SD] years), including 537 patients with hepatocellular carcinoma, 8 with metastases from neuroendocrine tumors, and 59 patients without reported etiology. Reported sensitivity of AFD ranged between 86% and 98.5%, compared to DSA alone (38% - 64%) or DSA in combination with CBCT (69% - 81%). Three studies reported tumor response by modified response evaluation criteria in solid tumors (mRECIST) guidelines, with complete response in the range of 60% - 69%. CONCLUSION: AFD is a promising new technology for the identification of intrahepatic and extrahepatic tumor-feeding arteries and should be considered a useful adjunct to conventional DSA and CBCT in the treatment of liver tumors.

Safety of early ambulation in patients undergoing ultrasound-guided femoral low angle arterial access technique (FLAT).

PURPOSE: To evaluate the safety of early ambulation in patients undergoing transfemoral arterial interventions via ultrasound-guided femoral low angle arterial access technique (FLAT). MATERIALS AND METHODS: A total of 58 patients undergoing 72 transfemoral arterial procedures that underwent an attempt at FLAT for femoral artery cannulation at our institution from November 2014 to July 2015 were retrospectively identified. Technical success was defined as obtaining less than a 35-degree angle of entry through the anterior wall of the common femoral artery. Patients for which a low angle was achieved were ambulated after 2hours after hemostasis was achieved with manual compression. All patients received out-patient clinic follow-up which included ultrasound examination of the femoral artery. Chart review provided demographic data, pertinent past medical history, procedural information (type of procedure, size of femoral access sheath, time to ambulation), complications related to arterial access and follow up. RESULTS: Twelve patients were excluded from the study due to inability to analyze ultrasound images. A low angle was achieved in 37 patients (17 men, 20 women; mean age: 58.5 years±13.1 [SD]) undergoing 45 procedures who met inclusion criteria for the study, yielding technical success rate of 75%. There was a moderate positive correlation between the access angle and depth of the common femoral artery at the site of puncture (r=0.45; P<0.01). All patients were followed up within 2 weeks of the initial procedure in the outpatient clinic. No arterial access-related complications occurred. CONCLUSIONS: Femoral artery cannulation using FLAT followed by manual compression and ambulation after 2 hours appears to be a safe approach.