key: cord-0016598-q2js7j3r
authors: nan
title: ECIO 2021 Book of Abstracts
date: 2021-04-07
journal: Cardiovasc Intervent Radiol
DOI: 10.1007/s00270-021-02819-z
sha: 5c253ad2c3f59e9260a70bab58133a8aa8981f96
doc_id: 16598
cord_uid: q2js7j3r

nan

glomerular filtration rate (GFR) decline between their basal and nadir values (mean basal GFR 65.9±22.4 ml/min vs mean nadir GFR 52.8±26.0 ml/min, p<0.001), but only two showed a clinically significant renal function decline. Five-year estimates of DFS, primary and secondary LRFS, and MFS were 45.4% (95%CI: 28.2-73.0%), 63.8% (95%CI: 46.9-87.0%), 88.9% (95%CI: 77.8-99.0%) and 75.2% (95%CI: 57.1-99.9%), respectively. No patients died due to renal tumor evolution. One patient died 52 months after CA due to CA-unrelated causes. Conclusion: Percutaneous CA for intraparenchymal renal tumors offers good oncologic outcomes with acceptable complication rates and renal function decline.

MRI-guided percutaneous cryoablation of small renal masses: automated 3D margin assessment using intraoperative MR-MR image fusion and correlation with local outcome N. de Jager 1 , T. van Oostenbrugge 2 , T. Pätz 3 , S. Jenniskens 1 , J.J. Fütterer 1 , H. Langenhuijsen 2 , C. Overduin 1 1 Radiology, Radboud University Medical Center, Nijmegen, NL, 2 Urology, Radboud University Medical Center, Nijmegen, NL, 3 

Purpose: To evaluate treatment margins of magnetic resonance imaging (MRI)-guided percutaneous cryoablation of small renal masses (SRMs) and determine correlation with local outcome. Material and methods: Retrospective analysis was performed on 31 patients who underwent percutaneous MRI-guided cryoablation for 33 SRMs (size: 0.9-4.5 cm). Tumors and corresponding ice-ball volumes were segmented on intraprocedural pre-and post-ablation MR images using Software Assistant for Interventional Radiology (SAFIR) software. After MRI-MRI anatomical co-registration, 3D ablation margins were automatically quantified. Minimal ablation margin was defined as the smallest three-dimensional distance between the tumor and ice-ball surface, where negative values indicate incomplete coverage. Local tumor progression (LTP) after cryoablation was assessed on follow-up imaging. Results: Median follow-up was 16 months (range: 1-58). Local control after cryoablation was achieved in 27 tumors (82%), while LTP occurred in 6 (18%). Minimal ablation margin was significantly smaller for cases with vs. without LTP (-6.9±3.5 vs. 2.6±1.7 mm, P<.001). No LTP was observed in patients with a minimal margin >0 mm. Cases with LTP had significantly larger tumor diameters vs. those without LTP (4.1±0.5 vs. 2.9±0.9 cm, P=.003). All negative treatment margins occurred in tumors >3cm. No significant differences were found for other baseline parameters. Conclusion: Minimal treatment margin appears a strong predictor of outcome after MRI-guided cryoablation of SRMs. Radiologically complete coverage (smallest margin >0 mm) was associated with absence of local recurrence. Intraoperative use of automated 3D margin analysis can be a valuable tool in predicting therapy success during percutaneous renal cryoablation procedures. (CSS) . Secondary outcome measures were kidney function, complications, technical success, hospital stay, procedural time, and the identification of factors affecting the primary outcomes. Results: Fifty-three consecutive patients with 54 lesions (T1a: 49/54; T1b: 9.3%) were included. Mean tumor diameter was 28.0±8.5mm and mean RENAL score was 7.2±2.0. Technical success was 100% (54/54 lesions) after two reinterventions for incomplete ablation. Mean time follow-up was 46.7±28.6 months (range: 3-122). Local recurrence was noted in 5 patients (9.2%). According to Kaplan-Meyer analysis OS was 98.2%, 94.2%, 71.2% and 58.2% at 1, 3, 5 and 8 years. One patient (1.9%) died of cancer and CSS was 95.8% at 8 years. DFS was 100.0%, 95.5% and 88.6%, and PFS was 100%, 94.3%% and 91.0%, at 1, 2 and 5 years. Clavien-Dindo grade II complication rate was 7.8% (5/64 procedures). There were no complications classified as grade III or greater. Mean creatinine increase was 7.1±6.3μm/L(p=0.31). No patient required dialysis during follow up. Mean procedural time was 163±45mins. Mean hospital stay was 2.2±2.2 days. Diabetes was the only independent predictor of decreased OS (HR 4.3, 95%CI 0.043-0.914; p=0.038). Conclusion: PCA provides favorable long-term oncological and renal function preservation outcomes with acceptable complication rates in stage T1a and T1b RCC.

Microwave ablation versus cryoablation in the treatment of patients with early stage renal tumors I. Thanou, K. Tavernaraki, N. Sidiropoulou, S. Arapostathi, P. Filippousis, E. Gerardos, L. Thanos Imaging and Interventional Radiology, Sotiria General Hospital of Athens, Athens, GR Purpose: To compare safety and efficacy between microwave ablation (MWA) and cryoablation in the treatment of localized renal tumors. Material and methods: We studied retrospectively 45 patients with renal tumors of stage IA (n=33) and IB (n=12) who underwent percutaneous ablation treatment (cryoablation: n=15,IA n=9, IB n=6 /MWA: n= 30, IA n=24, IB n=6). MWA procedures were performed under conscious sedation, whilst cryoablation sessions demanded only local anesthetic. All procedures were CT guided. Duration of MWA varied according to the ablative modality, the lesion size and the tumor stage. Results: A total of 52 ablation sessions has been performed. All sessions were technically successful. Clinical efficacy varied according to tumor stage and ablative method (IA lesions: MWA 95,8%, Cryoablation 100%/ IB lesions: MWA 66,67%, Cryoablation 83,34%). Residual tumors have been treated with a second ablation session. Follow up protocol included CT immediately postprocedurally and either CT/MRI 1,3,6 months and one year after treatment and yearly thereafter. No major complication did occur. Post ablation syndrome was reported to 7 patients. All patients were dismissed after 12h hospitalization. Local recurrence rates came up to 13,3% for both cryoablation patients MWA patients 6 months after treatment. All of them have been treated with a subsequent ablation session. Conclusion: Both MWA and Cryoablation are effective, minimal invasive techniques with low rate of potential complications, as well as, low rate of referred recurrences.

Percutaneous microwave ablation of renal cell carcinomas: mid and long-term results

A review of practice in percutaneous cryoablation therapy for renal cell carcinoma: a technologist guide

Interventional Radiology, Dept of Clinical Imaging, Hamad General Hospital, Hamad Medical Corporation, Doha, QA Learning Objectives: Discussing the epidemiology and mechanism of Renal Cell Carcinoma (RCC) Pre and Post Imaging findings on USG, CT & MRI Highlights the technique and principles for Cryoablation. Background: RCC is the most common type of kidney cancer in adults. The traditional treatment was partial nephrectomy. With the help of advanced imaging, RCC is now often detected in earlier stages. Cryoablation is a technique that eventually results in tissue necrosis, has become the standard nephronsparing option for RCC. Clinical Findings/Procedure Details: Cryoablation is performed by inserting a cryoprobe into the tumor. The probe rapidly removes heat from the tissue by means of Joule-Thompson effect, in which rapid expansion of a gas results in a change of temperature. A heat sink is produced near the antenna tip that cools the probe to temperatures of -160°C or colder. Heat is transferred from the tissue into the cryoprobe via passive thermal diffusion. Slow freezing produces intracellular ice crystals and fast freezing induces extracellular ice crystals. Both processes induce cell death by different cellular mechanisms. In addition, freeze-thaw cycles can induce cellular dehydration, vascular thrombosis, and membrane rupture. The number of cryoablation probes inserted into a lesion can also be varied, depending on the size and shape of a lesion. In contrast to MWA and RFA, cryoablation allows direct visualization of the approximate ablation zone, can be visualized in three planes under direct visualization. Conclusion: Percutaneous Cryoablation is a reasonable minimally-invasive treatment option for patients with RCC, providing favorable oncologic and safety outcomes compared to surgical and surveillance approaches.

Arterial embolization as a sole management of ruptured renal cell carcinoma in a patient with chronic renal failure

Clinical history/Pre-treatment imaging: A 55-year-old male patient with end stage renal disease on hemodialysis presented with sudden left flank pain associated with significant hemoglobin drop. CT examination of the abdomen was done and revealed a large lower pole ruptured RCC with large perinephric hematoma. The patient had acquired renal cystic disease with a prior right renal cell carcinoma which was resected one year before the current presentation. Treatment options/Results: The patient was prepared for an urgent embolization of the left kidney on the same day. Embolization of the left renal artery was successful using 3 coils (Tornado 7-3). Post coiling angiogram revealed complete devascularization of the kidney. Serial CT imaging at 1 week, 3 & 6 months showed complete necrosis of the left kidney with resolution of the perinephric hematoma. The patient was followed up for three years with no evidence of recurrence or metastatic disease. Discussion: Patients on chronic dialysis are at increased risk of RCC due to the development of acquired renal cystic disease. Thus, regular screening is usually recommended. In this patient, the left RCC developed over short period of time and presented acutely with perinephric hemorrhage. Treatment options include surgical resection and embolization. As our patient was unfit for surgery, embolization was performed and provided adequate control without need for subsequent nephrectomy. Take-home points: Arterial embolization is a life saving procedure in acute renal hemorrhage. Embolization can provide adequate bleeding and oncological control as a sole management in poor surgical candidates.

Multidisciplinary management of extensive renal cell carcinoma with inferior vena cava thrombosis with the use of removable cava filter (Capturex): a case report M. Curti, F. Piacentino, F. Fontana, C. Ossola, G. Zorzetto, M. Duvia, A. Coppola, M. Venturini Radiology and Interventional Radiology, Insubria University, Varese, IT Clinical history/Pre-treatment imaging: The most common cause of neoplastic thrombotic infiltration of the inferior vena cava is renal cell carcinoma, with a reported rate of 4% to 10% . Despite higher risks of perioperartive complications compared to typical radical nephrectomy, surgical resection and tumor thrombectomy in patients with renal cell carcinoma and tumor thrombus offers a potential survival advantage. We present a case of a patient with massive RCC with extensive tumor thrombus involving inferior vena cava (IVC). Treatment options/Results: Prior to surgical resection, a renal artery embolization (RAE) was performed in order to reduce the risk of intra-operative bleeding. Subsequently, we performed a combined endovascular and open surgical approach, consisting in nephrectomy, liver derotation and vena cava thrombectomy, with the support of a temporary inferior vena cava filter, positioned at the atrial-IVC junction in order to protect against thromboembolism during the procedure. Discussion: Due to the extension of the tumor in the retrohepatic tract of the IVC up to 2 cm from the right atrium, the use of Capturex device has allowed us to perform the cavotomy more safely, reducing the high risk of pulmonary embolism. Capturex has an internal 6 Fr shaft that allowed us to insert telescopically an additional catheter through which an intraoperative phlebography was performed, without moving the filter. Take-home points: -The use of a novel temporary caval filter(Capturex) have reduced the risk of intraoperative thromboembolic dissemination. -Capturex, in addition to its protective function, allow to perform other diagnostic or interventional procedure thanks to its 6 Fr working channel.

Purpose: Current European guidelines for treating colorectal cancer liver metastases (CRLM) patients that are not eligible for curative treatment include transarterial chemoembolisation (TACE) using irinotecan-eluting beads among treatment possibilities. The CIrse REgistry for LifePearlTM microspheres (CIREL) is a prospective, Europe-wide, multicentre, observational study on the real-life use of LifePearlTM microspheres TACE. In an interim-analysis, the treatment intention, periprocedural medications, safety and patientreported Health-related Quality of Life (HRQOL) were analysed. Material and methods: The first 50 patients (>= 18 years) were treated with irinotecan-eluting beads as decided by an MDT with no further inclusion or exclusion criteria. Periprocedural medications were recorded in the recruiting centres. HRQOL was analysed using the EORTC QLQ-C30 questionnaire and scoring manual. Results: The treatment intention for most patients (42%) was LP-irinotecan TACE as salvage therapy. 3 major groups of periprocedural medication strategies were identified. 33% of treatment sessions used opioids exclusively, otherwise antiemetic and NSAID plus either corticosteroids and intraarterial anesthetic (32%), or antihistamines and antibiotics (29%) were used additionally. SAEs were observed in 4% during treatment sessions and in 10% of patients within the first 30 days. Function and symptom scores remained stable in 74% and 72% of patients. 62% of patients reported a stable or better global health score. In the 38% with worse global health score, 54% were salvage therapy patients Conclusion: This interim analysis shows the predominant use of LP-irinotecan TACE as salvage therapy, confirms the acceptable toxicity profile and documents the lack of standardisation of periprocedural medications. The majority of patients reported a stable or improved HRQOL.

European Conference on Interventional Oncology

Purpose: To evaluate technical feasibility, safety and tumor control rate of balloon-occluded trans-arterial radioembolization (B-TARE) treatment in local advanced, unresectable, hepatocellular carcinoma (HCC) patients. Material and methods: Twelve Child A patients with unresectable HCC (BCLC-B) using balloon-occluded transarterial radioembolization (B-TARE) were included. Each patient received one session of B-TARE, in which was administered a median dose of 1.75 GBq (±0.18). Technical embolization endpoint was complete drug administration. Balloonoccluded arterial stump pressure (BOASP), adverse events (AEs), complications and post-embolic syndrome (PES) were assessed. Procedural oncological outcomes (per-patient and per-nodule) were evaluated according to RECIST 1.1 criteria on 1-and 3-month follow-up CT. Impact of balloon micro-catheter on trans-arterial loco-regional treatment was analyzed using 2D/3D dosimetry in post-procedural SPECT.

Results: Mean number of HCC nodules treated was 3.58 (±2,84) with mean diameter of 36.6mm (±19.81). Technical success was obtained for all procedures; no major complications were observed. In 2D evaluation, activity intensity peak was 987.5 (±393.8), that shows a high amount of Y90-microspheres delivered to the lesion. Regarding 3D dose analysis (expression of Absorbed Dose in Gy), mean dose <D> administered to treated lesions was 151.6 (±53.2), with low mean dose delivered to the normal liver (29.4 ±5.7). At 3-months follow up we obtained Complete Response (CR) in 5/12 patients, Partial Response (PR) in 3 patients and 1 Stable Disease (SD). Per-nodule examination demonstrated CR in 13/43 nodules (30.2%) and PR in 25/43 (58%). Conclusion: In our preliminary experience B-TARE seems to be a safe and effective local therapeutic option for unresectable HCC lesions, showing a high rate of local response.

Quantitative ablation margin assessment using a 3D liver model: can ablation surface coverage data contribute to better prediction of local tumor control? Purpose: The minimal ablation margin (MAM) has been proven to be a valuable predictor of local control after thermal ablation of liver tumors. However, a standardized way of determining this measure is currently lacking and tissue shrinkage during ablation may influence the MAM negatively.

We created a 3D model out of the pre-and post-ablation scans to gain insight in the value of different quantitative ablation margin measures, such as MAM and ablation surface coverage. Material and methods: 28 patients (age 64.8 SD: 8.7) with 45 hepatocellular carcinomas (mean size 18.8mm SD: 7.7) were included. 6/45 tumors were excluded for further analysis due to infeasible registration. By manually segmenting the tumor and ablation necrosis area, two 3D liver models were created that were merged using semi-automatic rigid registration of

Percutaneous cross mesh stenting for palliative treatment of perihilar malignant biliary obstructions with a novel metallic stent: technical aspects, safety, and clinical outcome Material and methods: Ethical committee approval was obtained for this feasibility study, in which 6 patients with unresectable liver tumours are treated. The SIRT procedure is split up: the catheter is placed under X-ray guidance as per usual, after which the patient is moved to an MRI scanner which is positioned directly adjacent to the hybrid OR. The total activity for each of the identified catheter positions is split in predefined fractions. MRI is performed during and after the administration of each fraction. All fractions for one catheter position are injected within one hour. Quantitative imaging is performed after each fraction and converted to dose maps using Q-Suite software to establish the T/L ratio and perform voxel-based dosimetry. Results: Recruitment is ongoing, with 5 out of 6 patients enrolled and treated successfully. The quantitative dose distributions provide promising insight into microsphere distribution in relation to the amount of microspheres administered. The intrahepatic distribution of microsphere fractions is not necessarily consistent between different fractions.

This study is an important first step to better understand SIRT fundamentally and this may lead to improving the therapy by increasing the T/L ratio, ultimately resulting in better patient outcomes.

Purpose: To assess the additive value of neoadjuvant chemotherapy (NAC) followed by repeat local treatment of patients with recurrent colorectal liver metastases (CRLM). are simplistic and only slightly personalized. Activity planning could also be based on a 99mTc-macroaggregated albumin SPECT/CT (MAA) using the partition model but its accuracy is controversial. This study evaluates doses in the non-tumoral (normal) and in the tumor liver compartments using the MAA imaging and post-therapy 90Y TOF-PET/CT (90Y imaging). Finally, we propose a prescription of the activity as a function of the normal liver MAA distribution. Material and methods: 66 procedures of RE (with resin microspheres) corresponding to 171 lesions were analyzed. Tumor to normal targeted liver uptake (T/NTL), tumor dose (TD) and normal liver doses (NLD) were assessed with MAA and 90Y imaging. Secondly, activities were recalculated using the MAA distribution in the NTL compartment to reach a target dose of 50 Gy or 70 Gy. Results: Our study demonstrated an accurate estimation of the NLD using MAA imaging (R=0.97, p < 0.001, variability = 1.9 Gy). In contrary, significant variations were found for TD (R=0.65, p < 0.001 and variability= 49.4 Gy). The MAA T/NTL ratio has a 85% positive predictive value in identifying patients who will get a 90Y T/NTL ratio above 1.5, which is likely to lead to positive therapeutic results.

The partition model is an imprecise model for estimating TD. However, NLD is accurately predicted with MAA imaging and could be used to safely plan the activity needed for treatment. Size, shape (roundness index) and volume (evaluated using the semiautomatic Lesion tool, Vue PACS, Carestream) of the ablation zone were recorded. Technical success was defined as complete target devascularization at the immediate postprocedural CT. 1, 3, 6 and 12 months post-procedure followup was performed and major and minor complications were reported. Results: Mean tumor size was 4cm (2.5-7cm). Full technical success was achieved in all treated liver malignant lesions. All ablative zones were spherical or ellipsoid with antennas spacing ≤2.0 cm. Artificial dissection was performed in 6 cases due to diaphragm proximity. In 6 cases peri-procedural complications were observed: one subcapsular hemorrhage, 4 cases of biloma and one peripheral portal thrombosis. We reported 2 cases of residual disease at 1 month and 5 cases of recurrence of disease at 3 months follow-up. All recidivated lesions had a maximum size ≥4.5cm (4.5-7cm) or were already surgically treated lesions. Conclusion: Our results provide preliminary evidence of efficacy, creating a larger necrotic area, and safety, for the low complication rate, of simultaneous MWA using multiple antennas for local control of liver malignant lesions.

Occurrence, related factors and prognostic value of vascular lake in hepatocellular carcinoma patients treated with drug-eluting bead transarterial chemoembolization . Impact of balloon micro-catheter on trans-arterial loco-regional treatment was analyzed using: post-procedural cone beam CT (CBCT) after TACE/b-TACE, 2D and 3D dosimetry in SPECT after SIRT/b-SIRT and histological count of the bead following orthotopic liver transplantation (OLT) in the subgroup of TACE/b-TACE. Results: Fifty-three patients were analysed in TACE group. Contrast, signal-to-noise ratio, and contrast to noise ratio were significantly higher in b-TACE subgroup than DEB-TACE. Thirtyone patients were analysed in SIRT group. b-SIRT had a better dosimetry profile both in 2D and 3D analysis. 2D evaluation showed an activity intensity peak significantly higher in b-SIRT subgroup compared with SIRT. Regarding 3D dose analysis, mean dose administered to treated lesions was significantly higher in b-SIRT group than SIRT. In specimen analysis, there was a trend for higher intra-tumoral localization of PEG microsphere for b-TACE in comparison with DEB-TACE.

The results of the present study quantify in vivo, thanks to the use of three different methods, the ameliorative embolization profile of oncological interventions performed with balloon-micro catheter regardless of the embolic agent employed.

Is visual estimation of liver lobe proportion sufficient to decide on the right distribution of the chemotherapeutic agent in uveal melanoma patients with liver metastasis undergoing hepatic artery infusion? In uveal melanoma patients, hepatic metastases can be treated by hepatic artery infusion (HAI). If both liver lobes have to be treated separately due to anatomical variants, volume proportion of both lobes are visually estimated on angiographic images in order to decide on the correct distribution of the chemotherapeutic agent. The aim of this study was to compare the visually estimated volume proportions on angiographic images with measured volume proportions between both lobes on CT to determine a potential aberrance. Material and methods: In this retrospective study, patients with uveal melanoma who underwent separate HAI of the right and the left liver lobe with melphalan as a chemotherapeutic agent were included. Volume measurements using syngo. via (Siemens Healthineers, Germany) of both liver lobes prior to first HAI were compared with the volume proportions described in the angiographic report by the interventional radiologist.

Results: A total of 67 patients (mean age 66.0 years ±11.4 (SD), 35 females, 32 males) who underwent HAI were eligible for analysis. Median aberrance between volume proportions measured in CT and angiography-based estimated values was 6.76 % (IQR: 3.16-11.07). In about 28 % (19 out of 67 cases) the aberrance of estimated volume proportion exceeded 10 %.

In uveal melanoma patients with liver metastases, the visual estimated volume proportion between right and left liver lobe matches liver volumes measured in CT. However, in cases with an atypical liver anatomy, CT volume measurement might be necessary to optimize appropriate distribution of the chemotherapeutic agent in patients scheduled for HAI.

Feasibility, safety and tumor control of balloon-occluded trans-arterial chemoembolization with Irinotecan (b-DEBIRI) for the treatment of colorectal cancer liver metastasis: preliminary results Results: DEB-TACE presented with higher objective response rate (ORR) and disease control rate (DCR) compared to cTACE. Regarding survival profiles, the short-term mortality rate was lower, and PFS as well as OS were longer in DEB-TACE group compared with cTACE group. Multivariate Cox's regression further illustrated that DEB-TACE vs cTACE was an independent protective factor for PFS and OS. As for safety profiles, patients' liver function injury was reduced in DEB-TACE group compared with cTACE group. The incidence of fever was lower and CINV were less severe in DEB-TACE group compared with cTACE group, while no difference in occurrence of liver abscess, increase of ascites or moderate pain between two groups was observed. Conclusion: DEB-TACE with CSM presents with better treatment response, survival profiles as well as safety profiles compared to cTACE in treatment for huge HCC patients.

Successful right portal vein embolization with ONYX in oncologic patients with massive hepatic right lobe involvement

Purpose: Evaluate feasibility and efficacy of ONYX as embolic agent in preoperative right portal vein embolisation to induce adequate left liver lobe hypertrophy before extended right hepatectomy.

We restrospectively considered between January 2019 and December 2020 23 patients(mean age 58,3 years; 12 males, 11 females)with radiological diagnosis(TC/RM)of extensive involvement of the only right liver lobe by cholangiocarcinoma (7), metastases (9) and HCC (16), with undamaged left hepatic lobe and future remnant liver <30%, in patients with normal liver, and <40% in cirrhotic patients. All patients underwent sonographically guided percutaneous puncture of Portal Vein, performed with a 21 G Chiba-needle,and then selective catheterisation of the main right branch and its ramifications with 5 Fr catheter and 2.7 Fr micro-catheter. In all cases we used ONYX-18.All patients underwent a CT scan before right portal vein embolisation and another CT scan 1 month after it was performed,to calculate total liver volume, tumour volu.me,future remnant liver and degree of induced compensatory left lobe hypertrophy Results: Technical success was achieved in all patient (23)with complete embolization of the right portal vein branch.In none of the cases we observed reflux of ONYX in the left portal vein branch and no major complications happened Conclusion: ONYX showed to be a very safe and effective embolic agent for preoperative right portal vein embolization, as it allows to get a complete embolisation of right portal branches, even smaller distal branches,with very low risk of reflux and higher probability to determine a satisfactory left lobe hypertrophy.

The univariate analysis showed that the pre-TACE blood urea, the presence of tumor thrombus in portal vein or in vena cava, albumin and small particle size microspherewere more likely to have severe post-TACE fever (P<0.001, respectively). However, in the Stepwise multiple regression analysis, the pre-TACE blood urea and small particle size were independent risk factors of severe post-TACE fever (P<0.001, respectively).

In conclusion, the pre-TACE blood urea and the size of the beads were independent risk factors for postembolization fever in HCC patients.Therefore, these factors should be taken into full consideration for the relief of fever.

Safety of using a transpleural approach for thermal ablation of hepatocellular carcinoma: a 9-year analysis in a tertiary centre There was no significant difference in rates of complications between a transpleural vs subcostal approach (p=0.68).

Conclusion: This study confirms that percutaneous ablation procedures performed for HCC have an overall low complication rate. In addition, this study shows no association between complication rate and transpleural approach suggesting that treatment of lesions should be encouraged when possible to ensure that patients are being treated with a curative intent rather than being offered palliative treatments. Results: Total AEs incidence was notably different among the RFA group, cTACE group and DEB-TACE group, and was the highest in cTACE group (86.2%), then in DEB-TACE group (76.6%) and the lowest in RFA group (63.3%). Regarding specific AEs incidence, the incidences of fever, fatigue, and nausea were distinctive among the three groups, while, no distinctiveness was found in incidence of other AEs. Furthermore, multivariate logistic regression revealed that cTACE (versus RFA) was independently correlated with increased risk of total AEs, fatigue, and nausea/vomiting, however, the interventional therapies were not independently correlated with the risk of pain, fever or constipation. Other independent predictive factors for total AEs risk were male, bronchial asthma, and disease duration. Conclusion: cTACE results in the highest AEs incidence compared with RFA and DEB-TACE in treating HCC patients.

Determination of risk factors for fever after transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

Purpose: To identify risk factors for postembolization fever after transarterial chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma (HCC).

In this retrospective study, a total of 188 consecutive patients who underwent DEB-TACE between June 2017 and May 2019 with post-TACE fever were included. The patients were divided into three groups based on the severity of post-TACE fever according to the degrees of body temperature. Potential risk factors for post-TACE fever were primarily analyzed by univariate analysis and multivariate logistics regression. Material and methods: From 2017 08 to 201909, the clinical data of 6 patients with liver abscess after surgery were analyzed retrospectively, the causes of liver abscess were analyzed, and corresponding nursing measures were taken.The causes of formation of liver abscess were further analyzed and corresponding nursing measures were taken. Results: The occurrence of liver abscess was related to previous history of minimally invasive treatment, damage of biliary mucosa or biliary obstruction, PVT thrombus, malnutrition and so on. In clinical nursing, we should strengthen the prevention of liver abscess and shock, and pay attention to high fever nursing, nutritional support and catheterization nursing. At the same time, psychological counseling should be given to patients. After active treatment and nursing, the adverse symptoms of 6 patients with liver abscess were effectively improved, the drainage of pus was reduced, and the condition of the patients controlled. All patients recovered and discharged smoothly. Conclusion: For liver couldcer patients treated with D-TACE and risk factors of liver abscess, the clinical treatment of antiinfection, liver protection and immunity should be done according to the actual situation of the patients, and proper nursing intervention could effectively improve the prognosis. Conclusion: For the patients with liver couldcer treated with D-TACE and risk factors of liver abscess, clinical treatments such as controlling infection, protecting liver function and improving immunity should be done, so as to give appropriate nursing intervention, these measures could effectively improve the prognosis of the patients.

Irreversible electroporation for the ablation of liver tumors in difficult to treat location (13), gallbladder cancer (6), metastases(2), pancreatic carcinoma(5) and HCC(2).In 19 patients stents were placed in a two-times approach, in 9 patients in a singlestep approach.The percutaneous transhepatic approach was performed under fluoroscopic guidance on the right side and under ultrasonographic guidance on the left side. In all cases a balloon-catheter pre-dilatation was performed before stent release. Clinical Findings/Procedure Details: Technical success was achieved in all patients (28). Clinical success was achieved in 23 patients; in 5 patients cholangitis occurred and we observed serum bilirubin level between 3 and 5 mg/dl. We observed 1 major complication constituted by bleeding into the biliary tree due to communication between the latter and the portal system, which solved spontaneously. 4 biliary peritoneal effusions occurred, solved by ultrasonographic placement of 8 Fr drainage catheter.The mean primary stent patency period was 103 days and the mean patient survival period was 150 days. Conclusion: Percutaneous bilateral stenting "side-by-side" is a feasible, safe and clinical effective method for palliative treatment of patients with malignant biliary hilar obstruction as it allows to relief from the symptoms associated with jaundice and so to improve significantly the quality of life of these patients and their mean survival period.

What is the best approach for biliary drainage of malignant hilar obstructions? 

Liver ablation: basics beyond novel

Learning Objectives: 1. To understand the importance of basics for achieving the best outcomes of liver ablation. 2. To remind the untold or forgotten tips and tricks rather than cutting-edge novel techniques. Background: Liver ablation is accepted as one of curative treatment options for early HCC in most HCC treatment guidelines. Many novel technical advances have contributed to improving the therapeutic outcomes and guaranteeing the safety. However, many more factors regarding the basics of procedure significantly affect the best outcomes. In this educational exhibit, five important basics will be presented with comprehensive illustrations. Clinical Findings/Procedure Details: There are five important basics for the best outcomes of liver ablation. 1. Careful selection of the best candidate is the first step to successful ablation. 2. Precise planning is the half of successful ablation. 3. Accurate procedure including punctual placement of applicators is critical. 4. Optimal ablation is the better strategy for the patiet with HCC, which will be continously recurred. 5. Learning from daily case is the essential way for the learning curve. If we keep the five basics in liver ablation, the safe and complete ablation can be guranteed in most cases. Conclusion: Basics should be always first in liver ablation. Novel techniques can't gurantee the successful ablation if we forget the basics in our daily practices was incidentally noted. The patient was asymptomatic in the interim and liver volumetrics did not show any hypertrophy of the future liver remnant. Given these findings the patient lost candidacy for a resection and was refered to interventional radiology for management. Treatment options/Results: We performed a left percutaneous trans-hepatic portal venous access followed by pharmaco-mechanical thrombectomy and portal vein venoplasty/stenting to restore flow in the left portal and mesenteric veins. At the end of the procedure brisk flow was seen in the left portal vein with persistent occlusion of the embolized right portal vein. The patient was discharged on anticoagulation and on follow up CT in one month was seen to have persistent left portal venous patency along with adequate hypertrophy of the future liver remnant from 33% pre-procedure to 42%. Discussion: This case illustrates a management strategy for non target porto-mesenteric thrombosis following portal vein embolization. Restoring portal flow is essential to preventing complications of portal thrombosis but this case shows that it can also result in delayed hypertrophy to maintain surgical candidacy. (Fig. 3) . Discussion: The primary tumour was unresectable and not suited for thermic ablation techniques such as RFA and MWA because of the close proximity to the major blood vessels and bile ducts. The tumor was too large to be treated with IRE. Take-home points: Stereotactic percutaneous ECT has the potential to be used as a safe and effective curative treatment method for HCC with diameters of more than 4 cm, even in close proximity to critical structures like major blood vessels and central bile ducts. %10-20 of all breast cancers. Interval type cancers; first and third years frequently metastasis to liver or brain and there is no standardized treatment for TNBC.We knew that percutaneus hepatic perfusion (PHP) is an effective treatment for chemotheraphy resistive metastatic liver tumors like uveal malign melanom. PHP treatment use with Melphalan and multidrug resistance very rare for this chemotherapy agent .TNBC liver metastasis treatment can be difficult with conventional methods. We suggest that PHP is an effective treatment method for TNBC liver metastasis but we need a large cohort study. Take-home points: PHP is an effective treatment for chemotheraphy resistive metastatic liver tumors We suggest that PHP is an effective treatment method for TNBC liver metastasis. (Figure 1 A) . The alfa-feto-protein level was 146 ng/ml. He was classified into BCLC Stage B with Child-Pugh (CP) score A. Treatment options/Results: DEB-TACE was planned for the patient. The right hepatic artery angiogram showed multiple arterial-feeders supplying the tumor. There was a non-targeted segmental branch arising just before the origins of arterial feeders ( Figure 1B and 2A) . The non-targeted segmental branch was first occluded with gelfoam in to divert all flow towards the targeted area ( Figure 2B ). The chemoembolization was then performed using 75 mg of doxorubicin with 100-300 μm microspheres. On follow-up, there was complete necrosis of tumor ( Figure 1C) and decrease in AFP level (2.2 ng/ml). Discussion: TACE has been recommended as the standard treatment for intermediate-stage HCC. The complete tumor response depends on overall drug-uptake within the tumor and amount of non-targeted chemoembolisation. The nontargeted segmental branch may be occluded with gelfoam to achieve increase uptake in the target area. However, it requires careful selection of the patients and depends upon the liver function and amount of non-targeted area to avoid postembolisation decompensation. Take-home points: The occlusion of non-targeted intrahepatic segmental branch before chemoembolisation may improve overall efficacy of DEB-TACE in cases of huge HCC and may help to achieve complete tumor response.

Discussion: A small bleeding appeared on the post-biopsy CT scan due to a puncturing of a small branch of the hepatic artery (Figure 2 .right), however, the following late phase (and angiography after) showed tamponade. The pathology showed a carcinoma with little differential, expressing CDX2 which means it is probably pancreatic-biliary. Take-home points: The use of CT-guided stereotactic navigation system allows the targeting of a lesion where previous ultrasound-guided attempt has failed.

Spontaneous intrahepatic bleeding from an HCC treated with transcatheter embolization using EVOH (Onyx) Treatment options/Results: Because of persistent RUQ pain and in order to prevent subcapsular haematoma formation or rupture within peritoneal cavity, decision was made to primarily treat the haemorrhagic nodule with transcatheter embolization. The superselective angiograms of S7 artery of the liver well demonstrated the expanding pseudoaneurysm with contrast leakage into the heamorrhagic HCC. Several embolic agents can be used in this setting, but we decided to embolize with EVOH copolymer obtaining an effective and durable haemostatic effect. Discussion: Spontaneous rupture is the third most common cause of death in HCC patients after tumor progression and liver failure. Thus, preventing or resolving haemorrhagic shock in such patients is the primary concern. Once the diagnosis of ruptured nodule is made, mainly with CT, surgery and transarterial embolization are the main therapeutic options with the latter less invasive but effective in haemostasis induction. Among various embolic materials (such as coils and particles) in our case we decided to use EVOH because of its filling and distal penetration properties. Haemostasis and pain control after procedure were effectively achieved. Take-home points: 1) Silent HCCs can present after spontaneous rupture with sudden abdominal pain and hypovolemic shock. 2) TAE with Onyx is effective to treat ruptured HCC. revealed raising of serum alpha-fetoprotein (10,411 IU/ml) and a 15x10-cm heterogeneous enhancing mass at right hepatic lobe, which suggestive of hepatocellular carcinoma. Treatment options/Results: Surgical resection was considered to be too risky because of the tumor size and patient general condition. Transarterial chemoembilization (TACE) was performed. Her hypoglycemia was successfully controlled within 24 hours after the first session of TACE. After another two subsequence sessions of TACE, the tumor showed significant decrease size to 8.3x4.8 cm. Right hepatectomy was done in September 2013. A 1.4-cm recurrent HCC was detected in February 2016 without any hypoglycemic symptom. The tumor was successfully treated with radiofrequency ablation. The patient is otherwise healthy without evidence of tumor recurrence until present. Discussion: The patients with hepatocellular carcinoma presented as hypoglycemic episode are uncommon. Hypoglycemic phenomenon was described to occur from tumor production of insulin-like growth factor II and tumor uptake of glucose. There are several treatment options for controlling hypoglycemia, including tumor resection, locoregional therapy of the tumor and medical treatments. For our patient, hypoglycemia was successfully controlled by the first session of TACE. Take-home points: -Although uncommon, hypoglycemia may present as an initial symptom of HCC. -This case demonstrated the successful treatment of hypoglycemic symptoms associated with large hepatocellular carcinoma by TACE.

Clinical history/Pre-treatment imaging: The patient (male, 75 years old) was admitted to the emergency department (HFR Fribourg) because he fell frontally on the head, presumably due to vasovagal collapse caused by abdominal pain. The CT showed an inhomogeneous mass (51x22mm) with a hypodense center in the hepatic hilum. C-Reactive Protein and Murphy's sign were negative. The tumor board decided for a biopsy of the mass. Differential diagnosis was lymphoma/ carcinoma. Treatment options/Results: An attempt with Ultrasound guidance failed and therefore biopsy under general anaesthesia with High Frequency Jet Ventilation with the support of a CT-guided stereotactic navigation system was considered (CAS-One IR, CASCINATION AG). Preprocedural screening showed only one possible access window to the suspected lesion, which passes in close proximity to the portal vein, hepatic artery and gallbladder (Figure 1 ). Three cylindrical samples were taken from the suspected mass (16G co-axial system with a 18G biopsy needle).

75 mg of Doxorubicin were injected with a good stasis at the end of the procedure.Balloon-Occluded DEB-TACE with Occlusafe was well tolerated by the patient and he was discharged at day 1. No alteration of liver function was observed. Grade 1 abdominal pain was present five days after the TACE. The MRI performed 1 month after the procedure had showed a complete devascularization of the tumoral nodule (complete response according to mRECIST). Tumor size decreased to 4,5x4,2 cm, necrotic zones. Patient was assigned to MW ablation procedure.Microwave ablation in 2 months after balloon-occluded TACE. The patient underwent a percutaneous MW ablation session by US-guided insertion of one 14G antennas (5 times 40 watts for 5 minutes) under general anesthesia. The Contrast CT was performed 1 month after the procedure and showed the complete response to the treatment (according to mRECIST). Great clinical efficacy. Next follow-up: Complete response for 12 months to combined treatment: bTACE+MWA.

Discussion: This clinical case shows the effectiveness of combined treatment of liver cancer by methods of interventional oncoradiology. Take-home points: We recommend the combined treatment of liver cancer with minimally invasive methods of interventional radiology.

CT-guided stereotactic ablation of 5 liver metastases from gastrointestinal stromal tumor was preferred over major surgical resection to preserve the parenchyma for future treatment options. The procedure was performed in the CT suite, with the patient under general anesthesia. Respiratory motion control (high-frequency jet ventilation) was used during the navigation procedure. A trajectory for each target was navigated using a tracked mechanical arm and the needle positions were verified with CT imaging. On completion of the ablation session, a contrastenhanced CT scan was fused with the planning CT scan and determine the tumor coverage by the ablation zone (see Figure 1 ).

The decision for percutaneous ablation intended to preserve parenchyma for future treatment options, as the patient is likely to develop more metastases. Furthermore, resection would imply the removal of multiple liver sections and prolong the hospitalization and time to recovery. Take-home points: With percutaneous navigated ablation a tissue sparing approach was chosen, to improve the patient`s quality of life and preserve options for future treatment. The aim of this retrospective study is to assess safety and efficacy of percutaneous lung ablation using an augmented reality CT navigation system (SIRIO) and comparing it with the standard CT-guided technique. Material and methods: Lung RFA and MWA were performed with a CT navigation system (SIRIO) in 52 patients and data were compared with a group of 49 patients undergoing standard CT-guided technique. The procedures were reviewed based on the number of CT scans, patients' radiation exposure, procedural time recorded, complications and 1 year follow-up. Results: SIRIO-guided LTA showed a significant reduction in procedure time, number of required CT scans and the radiation dose administered to patients (p < 0.001). A slight reduction in the complication rate was observed, probably due to a better identifications of the needle direction. In terms of local disease control, SIRIO did not demonstrated a significant improvement compared to the standard CT-guidance. To our knowledge this is the first clinical experience with a cohort of 101 patients inquiring the role of an augmented reality CT 3D navigation system in the lung ablative field. Conclusion: SIRIO proved to be a reliable and effective tool when performing CT-guided LTA displaying a significant (p<0.001) decrease in the procedure time and the radiation dose administered to patients. Clinical Findings/Procedure Details: Small nodules, gradually more often detected due to constant improvements of diagnostic equipments, are difficult to palpate intraoperatively. The same occurs with those nodules that are deep in the lung parenchyma or those that have no significant solid component. Beside the nodules characteristics, there are other factors such as pleural ou parenchymal fibrotic components that preclude the palpation of the lesions. Additionally, VATS removes the surgeons tactile perception, making the ressection of some small pulmonary nodules even more difficult. In order to solve the localization of small or non-palpable nodules for ressection with VATS, many different techniques have been developed, one of those being microcoil insertions under CT guidance. In this procedure, an interventional radiologist uses a CT scanner to find the lesion. Then, a needle, pre-loaded with a soft, fiber-coated platinum thread, is inserted percutaneously into the lung. Once the needle reaches the lesion, the radiologist releases the thread, allowing the surgeons to know the exact location of the nodule. Conclusion: Thus, this minimmaly invasive procedure contributes for a safer and shorter operative time. It also helps to treat patients sooner, the perfect complement to the effort made on early diagnosis. To determine if C-Arm cone beam CT (CBCT) is a viable alternative imaging guidance modality for percutaneous transthoracic needle biopsy (PTNB) in a community-based practice, and to determine the incidence of CBCT PTNBassociated pneumothorax compared to traditional CT-guided biopsy. Material and methods: At our busy academic community hospital interventional radiology practice, C-Arm CBCT was utilized during a three-month period when our dedicated procedural CT scanner was out of service prior to installation of a new machine. This study was prompted given perceived increased incidence of pneumothorax during that time. Given this subjective experience, a retrospective analysis was carried out comparing the pneumothorax rate during this period to the preceding six-month period, when traditional CT-guidance was preferably used. For the primary analysis, patients were grouped based on imaging modality. Additional subgroup analyses based on lesion size, pleural depth, and other clinical risk factors for pneumothorax were also carried out.

Results: There was no significant association between the imaging modality used for PTNB and subsequent pneumothorax (p=.69). However, there was a significant interaction between chest tube placement and diagnosed COPD (p=.03). Additionally, all patients requiring chest tube placement were either current or former smokers. This finding approached, but did not reach, statistical significance. Conclusion: This study did not confirm the perceived increased pneumothorax rate. However, these findings corroborate previously published literature, where complication rates between CBCT and traditional CT-guidance are reportedly comparable. Our experience demonstrates that CBCT can be successfully utilized in a community hospital setting, where limited resources prompt the need for alternative procedural approaches.

European Conference on Interventional Oncology were treated(46%kidney, 39%thyroid and 15%liver). All lesions underwent MRgHIFU,8 lesions were previously treated with RT and/or TAE.Good results were achieved in both groups, regarding pain palliation.Patients treated only with MRgHIFU showed a significant reduction in VAS score at 3 and 6 months(p=0,0490 and p=0,0294). Therapeutic success(complete and partial response)was obtained in both groups although with no significant differences(86%vs50% at 3m and 86%vs62% at 6m-p=0,2821 and p=0,5692 respectively).MR or CT follow-up studies were available for 12 lesions,mean dimension at baseline was 89,67±34 mm for lesions treated only with MRgHIFU and 93,25±20,8 mm for the other group. In patients treated only with MRgHIFU complete response occurred in 2 cases,stability in 2 and progression in 1.In the other group there were 2 complete,1 partial response and 2 cases of stability.No differences were found between groups regarding local response. Conclusion: MRgHIFU has the potential to serve as first-line treatment in hypervascular bone metastases considering the comparable results in terms of pain palliation and local control,alone and combined with TAE and RT.

Case presentation of percutaneous biopsy using robotic assistance under computed tomography guidance

Clinical history/Pre-treatment imaging: Percutaneous computed-tomography (CT)-guided interventions can beusedeffectively for image-guidedbiopsy and tumour ablation.However,the accuracy of CT-guided needle placement, which influences diagnostic yield, is highly dependent upon physician experience.In order to reduce the radiation dose of patients, improve the efficiency of surgery,Our navigation system successfully helps doctors solve these problems.and the following are case applications. Treatment options/Results: Improved needle accuracy with the use of this IR assistance platform for challenging,singlepass, multi-angle needle trajectories. Discussion: Improved needle accuracy with the use of this IR assistance platform for challenging,single-pass, multi-angle needle trajectories. Take-home points: The computer console communicates with the robotic guide arm via an RS232 interface to move according to the physician dictated plan. The robotic guide arm possesses 5 degrees offreedom and isable toachieveneedleinsertionsup to230mmfromthegantrycentrelinetothesideoppositethat of the docked device. Those needle angles or skin entry sites outside of this range mandate installation of another floor mounted docking plate on the other side of the examination table and  physical docking of the robotic on the contralateral table side. Once the robotic arm has moved to the correct location, the physician operator instructs the end effector of the robotic guide arm via the computer console to grip a plastic, gaugespecific needle guide (Fig. 1b) . The physician then manually inserts the needle through the needle guide until the needle hub contacts the needle guide.Once the needle is in place, the physician instructs the robotic device to unclamp its end effector and withdraw its robotic arm from the procedural site.

and affected area (cortical, medullary) were noted. The disappearance of the pain after the procedure was accepted as success criteria. The patients were routinely followed up daily after the procedure. Results: There were 14 male patients in the study. The mean age were 17.5 ± 8.67 and mean diameter of the nidus of the patients were 6.80 ± 4 mm, respectively. 10 nidus were cortical, 4 were intramedullary region. Lesions femur (n=11 ), tibia (n=2 ) scapula (n=1 ) was settled. The pain disappeared in all patients within 48 hours following the procedure. One patient had minimal burn enrty site, which resolved in a short time. No recurrence was observed in any of the patients until now.

The treatment success of RF ablation for OO is high. Procedure failure and recurrence rate is low. Posttreatment pain relief, early discharge and a short return to daily life are available. RF ablation procedure has prevented surgical treatment in appropriate lesion localizations. Procedurerelated complication rate is low. However, the burn during the procedure can be a serious problem.

Pain relief and local tumor control following percutaneous image-guided cryoablation for spine metastasis: a 12-years single centre experience Purpose: Percutaneous image-guided spine cryoablation (PIGSC) is a local treatment reported to be effective to achieve pain relief and/or local tumor control for metastases. The purpose of our study is to retrospectively assess pain relief and local tumor control for spine metastases. Material and methods: Between May 2008 and September 2020, 41 consecutive patients (mean age 59.7 ± 24.4 (range 27-84)) were treated for 46 spine metastases in 42 procedures. Population demographics, procedural data, complications, numerical pain scale before and after procedure (1-day, 1-month and last news given by the patient) and imaging follow-up were retrospectively investigated. Clinical success was defined as a decrease of ≥ 3 points on a 10-points numerical rate scale (NPRS) for the pain relief group and a total destruction of the tumor on imaging follow-up for the local tumor control group. Results: Among the 41 patients, 31 were treated for 36 spine metastases in 32 procedures for pain relief and 10 were treated for 10 spine metastases in 10 procedures for local tumor control. Clinical success for the pain relief group was achieved for 30/32 (93.8%) metastases, with a significantly decrease of mean NPRS from 6.2 ± 1.7 (range 3-9) before cryoablation to 1.9 ± 1.7 (range 0-7) at 1-month after cryoablation (p<0.005).

Clinical success for the local tumor control group was achieved for 6/10 (60%) spine metastases at a median of 25 ± 19 months (range 1-48) of follow-up. Conclusion: Percutaneous image-guided spine cryoablation (PIGSC) is effective in achieving pain relief or local tumor control for spine metastases.

Fluoroscopy guided uncooled microwave ablation in the treatment of osteoid osteoma is used as a popular method in osteoid osteoma (OO). The purpose of this study is to evaluate the complications and effectiveness of the procedure. Material and methods: Fifteen patients who were treated between February 2017 and September 2020 were included in study. RF procedure was performed in the CT unit under sedation anesthesia. Archive images and file record were analyzed retrospectively. Location of the lesions, nidus width Posters S41

were enrolled. Contrast-enhanced Magnetic Resonance (CE-MRI) and Computed Tomography (CT) spine exam were performed before and 6 months after the treatment. Visual analog scale (VAS) score has been administered before and 1 week, 1 month and 6 months after procedure; Oswestry Low Back Pain Disability Questionnaire (ODI) has been administered before and 6 months after the procedure. Technical success was defined as correct placement of the radiofrequency probe into the tumour target and subsequent completion of the vesselplasty.

Results: 17 lesions have been treated (13 lumbar, 4 dorsal) with RFA (RF3000, Boston Scientific, Marlborough, USA); subsequently, the Vessel system has been implanted with 100% technical success. No major complications occurred; 4 asymptomatic cement leakages into the intervertebral space have been registered. Preoperative mean VAS was 8.2; the mean VAS after 1 week 1 month and 6 months was 3.6, 1.8 and 1.4 respectively. Mean pre-operative ODI was 64.9% and dropped to 49.2%at 6-month follow-up. The 6-month followup CE-MRI did not demonstrate lesion growth. Conclusion: RFA + Vesselplasty promise to be a safe and effective minimally invasive treatment for painful primary or secondary spinal lytic lesions; no re-growth has been demonstrated with 6-month CE-MRI. 

Percutaneous liquid nitrogen cryoablation for bone lesions: feasibility and preliminary results D. Rossi, G. Bonomo, N. Camisassi, P. Della Vigna, D. Maiettini, G. Mauri, G.M. Varano, F. Orsi Department of Interventional Radiology, IEO, Milan, IT Purpose: To assess safety and feasibility of cryoablation using a liquid nitrogen-based cryogenic system in patients with metastatic bone lesions. Material and methods: Between January to December 2020, 9 patients (4 females, 5 males, mean age 68, range 53-75) underwent 9 cryoablations for metastatic bone tumours. Histological diagnosis included 3/9 (33%) renal cell carcinomas (RCC), 2/9 (22%) lung carcinoma, 1/9 (11%) breast carcinoma, 1/9 (11%) sarcoma, 1/9 (11%) mesothelioma and 1/9 (11%) colorectal cancer. The inclusion criteria included limited symptomatic metastasis, recurrent skeletal disease with either osteolytic or mixed osteolytic-osteoblastic features. All cases were contraindicated for other treatments, such as surgery or radiotherapy, due to comorbidity or prior irradiation. All treatments were performed in a dedicated angiography room setting in patients under general anesthesia using a liquidnitrogen based Prosense Cryosurgical system (IceCure Medical Ltd, Caesarea, Israel) under CT guidance.

The primary technical success overall was reached in 9/9 cases (100%). Two or three cycles of cryoablation were performed with a mean procedure duration time of 45 minutes (range 12-120 minutes). At a median follow up of 5 months, two minor adverse events (AEs) were reported in 2/9 lesions (22%). No major AEs or severe adverse events (SAE) were reported. Conclusion: CT-guided cryoablation is clinically safe and feasible. Longer follow-up and a larger group of patients are needed to obtain stronger clinical outcomes. 

Role Interventional radiology (IR) can provide effective solutions with minimally invasive techniques in the first line or alternative therapeutic approach of benign and malignant bone tumors or pseudotumors. IR may have curative purposes, as is the case with infiltration of sclerosing substances, application of percutaneous ablative techniques or use of percutaneous cementoplasty (e.g., intracystic injection in aneurysmal bone cyst, percutaneous thermal ablation in osteoid osteoma, osteoblastoma, symptomatic hemangioma or single bone metastases) or palliative purposes (e.g., percutaneous thermal ablation for local control of the progression or pain in certain bone metastases). Clinical Findings/Procedure Details: This case series aims to illustrate the different possible applications of IR in the percutaneous treatment of tumors and bone lesions, the techniques and materials used and the clinical results obtained. The included techniques are: 1. Percutaneous injection of doxycycline and/or steroids 2. Percutaneous cementoplasty 3. Percutaneous radiofrequency and microwave ablation 4. Peritumoral injections and neurolysis Conclusion: There are numerous minimally invasive therapeutic options that interventional radiology can provide in the treatment of bone tumors and pseudotumors, which have good clinical outcomes both for curative or palliative purposes. Following positioning of 6F Mach1 guiding catheter (BSCi) in the SMA complete Onyx fragment extraction was performed by creating negative pressure with 20 ml syringe connected via manifold to 5F Sofia distal access catheter (Microvention). Post procedural period without signs of intestinal ischemia. Discussion: Mechanical thrombextraction using thrombextractors or snares is not an option for retrieval of the migrated soft polymerized liquid agent due to potential fragmentation and distal embolization of ONYX. Take-home points: Liquid embolic agents are highly effective, but possible complications could be treacherous. In case of non-targeted embolization as for liquid embolic agents transcatheter aspiration with distal access catheters is the method of choice. Such bailout procedures require long learning curve and better be performed by experienced interventional radiologist.

Purpose: Our aim was to develop method of FLR augmentation that not only decrease patients dropout due to tumor progression but possible enable anticancer In Situ immunization during prolonged waiting period of FLR regeneration in patient with LC. Material and methods: 3 patients with small FLR and advanced HCC and LC were treated. Selective transarterial chemoembolization with doxorubicin 50mg and short term biodegradable starch microspheres(DSM-TACE), into tumor bearing liver to be resected, was simultaneously followed by PVE of latter. Upon completion of PVE selective intratumoral immunotherapy(HIT-IT) with atezolizumab 1200mg into restored after DSM-TACE tumor arterial feeders (for selective connection with PD-L1 ligands located on tumor cells but not on normal human tissues) was done. DSM-TACE and HIT-IT was repeated one more time in all patients after postzenith decrease of T-cytotoxic cells level in peripheral blood had started. Anticancer immune response was investigated by comparison of Initial histopathology specimen with specimen obtained just before second DSM-TACE+HIT IT and finaly with specimen of resected tumor bearing liver.

All patients had successfully underwent liver resection upon sufficient FLR regeneration. In all 3 cases we had achieved effective local tumor control via total or subtotal HCC necrosis. There were no severe morbidity or Immune-related adverse events (irAEs).

We had proposed new, aggressive but safe, method of FLR augmentation for patients with HCC and LC that could potentially preclude drop out of patients during anticipated prolonged waiting period of FLR augmentation and possible improves long-term outcomes by HCC immunoscore conversion. 

To turn weakness into a strength -preoperative future liver remnant (FLR) augmentation with special focus on local tumor control and in-situ immunization for patient with advanced hepatocellular carcinoma (HCC) and liver cirrhosis (LC)

Results: Early interventional oncology case study results will be presented, including a renal AML embolization and a portal vein embolization. In these cases, GPX exhibited good visibility and material casting in the vasculature. Target regions were fully occluded at the first angiogram (taken immediately after delivery), and the procedures were considered technical successes. In the operator handling survey, GPX offered excellent control, helping to preserve parenchyma in the AML embolization. Patients were all discharged within the expected timeframe (next day) and exhibited typical post-embolization symptoms. Conclusion: Early clinical cases with the GPX Embolic Device in oncology have been promising, with these cases meeting the desired clinical endpoints. A larger pivotal study is planned. In all patients percutaneous cryoneurolysis was performed with posterolateral paravertebral approach using a 17 Gauge cryoprobe under computed tomography guidance and local anesthesia. Self-reported pain scores were assessed before and at the last follow-up using a pain inventory with visual analogue scale (VAS) units. Results: Mean patient age was 63.81 years (male-female: 3-2). Mean pain score prior to cryoanalgesia of splanchnic nerves was 9.4 VAS units. This score was reduced to a mean value of 2.6, 2.6 and 3 VAS units at 1, 3 and 6 months of followup respectively. All patients reported significantly reduced analgesic usage. No complication was reported according to the CIRSE classification system. The mean procedure time was 44.4 minutes (range 39-50 min), including local anesthesia, cryoprobe(s) placement, ablation and post-procedural CT evaluation. Conclusion: Percutaneous cryoanalgesia of the splanchnic nerves is a minimally invasive, safe and effective procedure for pancreatic cancer pain relief. A larger, randomized trial is justified to substantiate these findings.

Advances in interventional oncology in the management of head and neck malignancy 1. Review the current successes for intra-arterial therapy in head and neck cancer 2. Illustrate the current strategies employed to improve the optimal delivery of therapeutics to the target tissue 3. To discuss the limitations and future directions in this emerging field Background: Malignant gliomas remain a challenge in oncology with most carrying a poor clinical outcome with existing therapies. Novel biologic therapies combined with advancements in neuroendovascular technologies have shown promise and have enabled endovascular selective intra-arterial (IA) approaches to delivery. Selectively targeting tumor vasculature may improve the efficacy of novel therapeutic agents and this approach has shown success in the management of retinoblastoma. Challenges remain including transportation across the blood brain barrier (BBB) and blood tumor barrier (BTB), we review modern approaches to this problem. Clinical Findings/Procedure Details: The development of contemporary microcatheters and the evolution of innovative endovascular selective intra-arterial (ESIA) approaches to treat cerebrovascular disease, IA delivery, and more precisely ESIA infusion, has arisen as a potential delivery strategy for the treatment of brain tumors. The limited progress made in intra-arterial therapy are due to challenges in selection of the therapeutic agent, the optimal delivery (rate, location, method), and the chemosensitivity of tumours for example GBM. Conclusion: Interventional neuro-oncology is an emerging field that applies modern techniques to the delivery of therapeutic agents to head and neck tumors. Advances in microcatheter technology have made super-selective distal intracranial arterial access reliable and safe and enable the development of novel targeted treatment strategies which may serve as an important pillar in personalized oncological management.

ECIO 2021 -Abstract Book Posters patients with PPH: 8/46 (17.39%), 90 day mortality in primary AE group :5/13 (38.46%), preventing re-exploration:7/13 (53.85%). Intra-abdominal fluid collection : Total patients -173/758 (22.8%), Underwent primary IR intervention -147/173 , Percutaneous drainage -141/147 (95.9%), Aspiration -6/147 (4.1%). IR in preventing re-exploration-135/147 (91.84%), 90 day mortality in primary IR group-9/147 (6.12%), 90 day mortality in patients with intra-abdominal fluid collection-14/173 (8.1%), Biliary complications -31/758 (4%), Bile leak -28/31(90%), PTBD-10/28 (35.7%) , PTBD + SEMS-5/28 (17.85%), Primary IR group-8/31 (58%), 90 day mortality in IR group -5/18 (27.78%), 90 day mortality -8/31(25.8%), preventing re-exploration -16/18 (88.89%). Conclusion: IR plays a vital role in the management of complications following major pancreatic surgery. It provides a minimal invasive alternative in selective patients and helps in reducing recovery time and preventing morbidity associated with re-look laparotomy. IR procedures are safe and effective and the synergistic role of interventional radiologist provides minimally invasive approach in the management of post pancreatectomy complications while reducing the need for re-operation.

Analysis of the application value of 3D rotational DSA in prostate artery embolization J. Lv, K. Liu, Y. Shen, J. Li Department of Interventional Radiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, CN Purpose: To investigate the application value of 3D rotational DSA in prostate artery embolization (PAE). Material and methods: A total of 73 cases of patients with benign prostatic hyperplasia (BPH) treated with PAE were selected in the Department of Interventional Therapy, The Fifth Affiliated Hospital of Zhengzhou University from August 2016 to June 2020. All patients were accepted conventional two-dimensional DSA (2D-DSA). Subsequently, focusing on the orthotopic blood vessel image, the image was acquired by rotating the C-arm, and the acquired images were sent to the 3D workstation to complete the reconstruction of the prostate artery. All pictures were reviewed by two physicians with advanced professional titles. The number, origin, and anastomotic branch with adjacent arteries of the prostatic arteries in conventional 2D-DSA and 3D rotational DSA imaging were observed. Results: The Kappa value of 2 doctors in the interventional department reading the film to identify the consistency of the prostate artery was 0.734. In 146 cases of internal iliac artery, 4 cases were excluded because of incomplete branches of internal iliac artery, 148 prostate arterieswere demonstrated in 142 lateral internal iliac arteries by conventional 2D-DSA and 3D rotational DSA. The 3D rotational DSAdemonstrated 143 (96.62%, 143/148), while the conventional 2D-DSA demonstrated 116 (78.38%, 116/148), the difference was statistically significant (χ2=22.517, P<0.001). Conclusion: 3D rotational DSA applied in PAE surgery can more clearly identify the number and origin of prostate artery and its complex anatomical structure. Therefore, it is of great significance to improve the effect of embolization.

Percutaneous ablative treatment of adrenal metastasis using an augmented reality navigation system (SIRIO) F. Eliodoro, G. Pacella, C. Altomare, G. Castiello, F. Andresciani, R.F. Grasso Department of Radiology and Interventional Radiology, University of Rome "Campus Bio-medico", Rome, IT Purpose: Evaluate efficacy and safety of percutaneous ablation techniques in unresectable adrenal metastasis performed using an augmented CT-guided reality navigation system, focusing on local tumor control, complications and survival outcomes. Material and methods: Data regarding patients with adrenal metastasis, histologically proven and treated with ablation techniques, were reviewed retrospectively. All procedures were performed under SIRIO-guidance. Primary study objectives such as technical success, primary and secondary technique efficacy rates, local tumor progression (LTP) rate, LPT-free survival and overall survivals (OS) were assessed. Secondary study objectives included assessment minor and major complications. Results: Eighteen patients (mean age of 65 yo) underwent 3 RFA (11%), 8 MWA (29%) e 17 CRA (60%). Technical success rate was 89%; primary and secondary technique efficacy rate was 79% and 93%, respectively. During follow-up, 6 cases experienced local disease progression, of which 3 treated successfully with second ablation. Residual tumor happened in 3 of 28 cases (11%) and LTP occurred in 3 of 28 cases (11%) with a mean LTP-FS of 55.7 months. Five-year OS was 77.8%, with a mean survival time of 61.9 months. Eight (28%) patients experienced major complications: 2 patients a self-limiting bleeding, 5 patients a hypertensive crisis pharmacologically managed and one pneumothorax due to a trans-pleural approach. Conclusion: The results of our study confirm the appropriateness of percutaneous ablation techniques for the treatment of adrenal metastasis and highlight the use of an augmented reality navigation system (SIRIO) for the approach of such complex location.

Results: Among 392 patients with oesophageal malignancy, less than 1% had immediate or long term complications post stenting. Among 31 patients with other cancers, no immediate or late complication was recorded. Among 23 patients with benign strictures, 9% reported immediate and long term complications. Among 7 patients with post-operative oesophageal leakage, there were three immediate and one long term complications. No procedure-related deaths was recorded within our patient cohort. Average time to death after palliative oesophageal stenting was 5 months for patients with oesophageal cancer and 2 months for other cancers. The technical success of oesophageal stenting was 100%, with only 2% of patients requiring re-intervention at 30 days and less than 1% at 1 year. Conclusion: Oesophageal stenting is a safe procedure for the palliation of dysphagia caused by advanced oesophageal cancer or malignant extrinsic compression of the oesophagus. In our experience there is minimal post-procedural complication and mortality, which is comparable with published studies. Results: 99 patients (60 males and 39 females) have been analyzed with a mean age of 62.8 years (range: 35-83 years). The tumor location was: 55 in the pancreatic head/ uncinate process (55.6%), 32 in the body (32.3%), and 12 in the tail (12.1%). The mean size of the lesions was 42.4 mm (range: 10-100 mm). 69 CNB (69.7%) were performed via indirect access (36 transgastric, 13 transhepatic, 9 transhepatic and transgastric, 4 transcolonic, and 7 others) and direct transperitoneal access was used in 30 cases (30.3%). Histologic analysis was performed on all biopsies, and diagnoses were conclusive in 97% (96/99) of cases. Sensibility and specificity for detecting malignancy were 87.3% and 100%, respectively. 10 patients (10,1%) had minor complications and there was a major complication with severe acute pancreatitis and death in a patient with an adenocarcinoma stage IV (1%). Conclusion: CT-guided percutaneous CNB is a feasible and safe method for diagnosing pancreatic malignancy.

Transradial versus transfemoral access for uterine artery embolization: analysis of radiation, cost and ancillary parameters A. Ghosh, V. Gupta, P. Sitwala, M. Stanley, S. Cai, N. Akhter Interventional Radiology, University of Maryland School of Medicine, Baltimore, MD, US Purpose: Transradial access (TRA) has become more popular in body intervention procedures, but has not been ubiquitously adapted. This study was designed to compare transradial to transfemoral access (TFA) in uterine leiomyoma patients who underwent uterine artery embolization (UAE). Material and methods: In this study, 172 UAE procedures conducted at our institute from October 2014-June 2020 were retrospectively analyzed. The transradial access group included 96 procedures while the transfemoral access group included 76. Peak skin dose (PSD), fluoroscopy time, procedure time, materials cost and administered contrast volume for each procedure were evaluated for statistical differences between the two groups. Results: All cases were technically successful without major complications. The average PSD presented with no statistical difference between TRA and TFA ( 2,498 mGy vs. 2,001 mGy, P>0.05). The average flouroscopy time also showed no statistical difference (26 min vs. 23 min, P>0.05). Similarly, the average in suite procedure time revealed no statistical difference between TRA and TFA (104 min vs. 94 min, P>0.05). The average materials cost also presented no statistical difference ($2,481 vs. $2, 061, P>0.05). Lastly, the average volume of contrast utilized between the two groups showed no statistical difference (144ml vs. 128 ml, P>0.05). Conclusion: With respect to many pertinent parameters, TRA was evaluated as an equally efficacious alternative to TFA in UAE procedures. Given the increased patient preference of TRA over TFA as described in literature, this study's findings further augment the claim that TRA should be considered more often, whenever viable, as an option in the UAE treatment of uterine leiomyomas.

Seven-year single centre outcomes for oesophageal stenting: retrospective analysis of 454 procedures J.Y. Kuah 

Endovascular treatment of emergencies in oncology: overview and case reports

Learning Objectives: Acute, hemodynamically destabilizing bleeding in cancer patients is an emergent situation that is increasingly encountered in interventional radiological practice. The most common cause of these conditions is the invasive growth of tumors into the surrounding structures, the breakdown of tumor tissue. Alternatively, acute bleeding occurs after open surgical or minimally invasive diagnostic and therapeutic procedures. Endovascular interventions have become an indispensable part of the management of these emergencies, mostly in patients with inoperable cancer. Background: In interventional radiological practice, we most often encounter acute bleeding in patients with inoperable carcinoma of the cervix, kidney, bladder, prostate, or bleeding from the upper and lower GIT and liver. Furthermore, with bleeding and venous stenoses in lung tumors and unstoppable bleeding in the orofacial area. The advantages of interventional radiological procedures are their miniinvasiveness with less perioperative mortality and morbidity, low number of complications and rapid achievement of hemodynamic stability. At the same time, there is the potential to to intervene in conditions that are unsolvable with conventional surgical, analgesic and oncological procedures. The result is an improvement in the overall survival of the patient, an improvement in the comfort of the patient's life, or the induction of partial remission. Clinical Findings/Procedure Details: With case studies, divided into anatomical regions, I want to point out the possibilities of endovascular treatment in emergent conditions in oncology. Conclusion: I believe that through mutual communication and closer cooperation with the relevant medical departments and authorities, we will be able to establish mini-invasive radio interventional procedures more firmly in the healthcare system.

Percutaneous cholecystostomy as a palliative treatment in end-stage malignant billiary obstruction M. Georgiadou, D. Zorbas, V. Nikolaou Radiology Department, General Hospital of Nikaia-Piraeus, Nikaia, Piraeus, GR Purpose: Percutaneous cholecystostomy (PC), commonly placed to treat acute cholecystitis in critically ill patients, is also being used as a palliative measure in patients with unresectable neoplasmatic end-stage disease. In the present study, we evaluate the use of PC in patients with obstructive jaundice due to malignant billiary obstruction. Material and methods: From 2013 to 2020 patients with malignant billiary obstruction, non eligible for other theurapeutic treatment (interventional, endoscopic, surgical) underwent PC. Authors evaluated the use of PC in this patient group as far as the type of malignancy, the techniques, the complications and the primary outcomes are concerned. Results: Out of 147 patients who underwent PC in our department during the study period, 13 were treated for obstructive jaundice due to malignant billiary obstruction. All of them were not eligible for other therapeutic methods (interventional, endoscopical, surgical) due to advanced metastatic disease or poor clinical status: 8 (63%) were diagnosed with advanced metastatic disease while the remaining 5 (37%) had pancreatic neoplasia. PCs were performed with either the trocar (n=12) or the seldinger technique (n=1). There was a 100% success rate, without any major or minor complications. In all cases remission of obstructive jaundice was observed . All patients were discharged from hospital. Conclusion: PC is a safe and efficient method for the palliative treatment of malignant billiary obstruction cases. Due to its effectiveness and low complication risk it should be considered as a therapeutic approach in end stage patients. Background: Defined as rupture of the extracranial carotid arteries or their major branches, carotid blowout syndrome (CBS) is an uncommon but potentially fatal complication in patients with head and neck malignancy. CBS usually arises following surgery, and is often associated with postoperative complications. A history of prior radiotherapy is almost invariable. Surgical management can be very challenging in this condition, with the prospective surgical field often involving previously irradiated or infected tissues. Today, with 1. Without contrast medium for substraction purposes and to look at the lesion itself. 2. Arterial phase: anomalies of the arteries and the new/ only tumor vessels 3. Early venous phase to see bigger a/v communications because of tumor necrosis and some other early veins as renal-or portalvenous system depending of the region of interest 4. Equilibrium phase to see the bigger veins such as vena cava sup/inf., liver/ thoracic/arm/leg veins TWIST/other new sequences help to cover of the anatomy in shorter times -2 min angio all in one MRA planning details will be povided Choosing the right embolization material(s) in the special case Plan stent length/ diameter/material details/access side eg. for vena cava ect. Image interpretation additionaly to the often very short report of an outside radiologist. Conclusion: MRA/MRV help to plan the oncologic vascular procedures, save tabel time and radiation for the in interventionalist / patient and protect kidney fom detorioration of renal function due to low amount of cyclic Gd contrast media.

The Background: Vascular malformations should be considered as a congenital endothelial malformation that results from a disruption in vascular morphogenesis. According to their hemodynamic characteristics, they can be classified as a lowflow or high-flow vascular malformation. Inflammation and fibrosis caused by damaging the endothelium is the goal of sclerotherapy, and it is particularly effective on LFPVM because most of their volume is static. For this reason, this review will focus mainly on this subgroup. Clinical Findings/Procedure Details: Clinical scenario and imaging findings will vary depending on the LFPVM in hand. We will be discussing the importance of imaging not only to reach an accurate diagnosis but also to plan the best percutaneous approach. The percutaneous treatment has been widely demonstrated as an effective and minimally invasive option for LFPVM. A detailed description of the procedure will be given with special emphasis on Bleomycin and its advantages over other sclerosing agents. Conclusion: LFPVM are generally treated percutaneously, therefore, it is important to be familiar with the imaging findings, the technical approach, and the different sclerosing agents available. Background: Chronic pelvic pain is a common presenting symptom in female patients and has been reported to account for approximately 10% of outpatient gynecologic visits. Chronic pelvic pain is defined as noncyclic pelvic pain of at least 6 months duration Clinical Findings/Procedure Details: The venography for PVI include a diameter of at least 5 mm in the gonadal, uterine, and utero-ovarian arcade veins, free reflux in the gonadal vein, reflux of contrast material across the midline to the contralateral side through the utero-ovarian arcade, opacification of thigh or vulvar varices, and stagnation of contrast material in pelvic veins Multiple methods of therapy for PVI have been used, including medical management with hormone analogues and surgical options. Less invasive approaches to treatment include transcatheter embolization of the ovarian or internal iliac veins The ovarian veins are approached from either a femoral or a jugular route; we prefer the jugular approach. A 7-French sheath is placed into the inferior vena cava, and a 5-French guiding catheter is used to select the left renal vein. A guidewire is then manipulated caudally into the left ovarian vein, and digital subtraction venography is performed. The ovarian venous plexus is then coiled Embolizing agents include coils, sclerosants, and glue alone or in combinations. Conclusion: Noninvasive diagnosis may be made with transvaginal duplex US or dynamic time-resolved MR angiography. PVCS due to PVI is treated with minimally invasive embolization and sclerotherapy with excellent clinical improvement.

A rare case of acquired uterine arteriovenous malformation due to cervical malignancy successfully managed with uterine artery embolization Treatment options/Results: Patient was brought to the operating room, however, due to difficulty in identifying a bleeding source, vaginal packing was applied and the patient was transported to the angiographic suite. Pelvic angiogram demonstrated a dilated and tortuous left uterine artery terminating into a vessel tangle consistent with left sided arteriovenous malformation. Embolization with 300-500 micron particles was performed until angiographic endpoint of stasis. Post-embolization angiography did not show any additional vascular abnormalities. Patient had an excellent recovery and was discharged 2 days later. Discussion: Uterine AVM is a rare cause of vaginal bleeding with less than 100 cases reported. Among them, acquired uterine AVMs related to cervical carcinoma appear sparingly. Two most common treatments include hysterectomy and uterine artery embolization. Our patient had a recent severe hemorrhagic event with concurrent cervical carcinoma. Embolization proved to be an excellent option for diagnosing the cause of hemorrhage and preventing recurrent hemorrhage in an anemic patient. Take-home points: Uterine artery embolization is both an appropriate diagnostic and therapeutic option in patients with AVM and concurrent gynecological malignancies as the pelvic anatomy is often deformed due to radiotherapy and recurrent cancerous tissue. Such cases are suboptimal for a surgical approach and may increase morbidity.

penetration, depending on the size of the particles. In fact, the use of smaller particles can penetrate more distally into the beds of tumor capillaries, but they can also increase the risk of major complications, include nerve paralysis and stroke by embolic particles. Take-home points: Endovascular embolization is often employed in conjunction with surgical techniques in an attempt to minimize morbidity and improve changes for successful tumor resection. Figure 1A ) revealed a large heterogeneous mass lesion having cystic spaces showing yin-yang color flow. Treatment options/Results: Patient was taken for emergency uterine artery embolization. Super-selective cannulation of both uterine arteries were done. Right uterine artery angiogram showed an arterio-venous malformation (AVM) and multiple pseudoaneurysms ( Figure 1B and C). These were embolized using 50 % glue mixed with lipiodol ( Figure 1D ). The left uterine was embolized using gelfoam slurry and PVA particles. Second cycle of chemotherapy was started after one week of embolization. CEMRI pelvis after 6 weeks revealed complete necrosis of tumor mass ( Figure 2 ). It employs a 1.1 MHz transducer, and thus it is suitable for percutaneous ablation of deep tissue, drug delivery, and blood brain barrier opening.

The performance of the device in terms of MR-compatibility, positioning accuracy, and reliability was evaluated in agar-based phantoms, excised tissue, and in vivo thigh tissue of rabbit models in both laboratory and MR environments. The positioning error was measured utilizing a specially designed structure with an integrated digital caliper. Its functionality in terms of temperature evolution during high intensity focused ultrasound (HIFU) exposures was evaluated utilizing MR thermometry. Results: Well-defined cigar-shaped lesions arranged in discrete and overlapping patterns were produced successfully. Accordingly, in vivo experiments resulted in local coagulative necrosis without destructing healthy intervening tissues. The average positioning error was found to be 0.11 mm. Conclusion: Overall, the device maintains high standards of animal welfare. It can be safely operated inside the scanner of any commercial MR imaging system up to 7 T to treat small animals. In the future, the device could be scaled up to manage abdominal cancer in humans.

Embolisation of adrenocortical carcinoma (ACC) metastases for uncontrollable hypertension N. Heptonstall, A. Winterbottom Interventional Radiology, Addenbrookes Hospital, Cambridge, GB Clinical history/Pre-treatment imaging: A patient with metastatic Adrenocortical Carcinoma (ACC) and Cushing's syndrome was admitted with hypertensive crisis with a blood pressure of 240/120. Her previous surgical history included a right adrenalectomy and left hepatectomy and right RFA for liver metasteses. Recent CT demonstrated an increased large right pelvic soft tissue mass within the right acetabulum and ischium with a pathological fracture of the anterior column requiring urgent complex orthopaedic fixation. Despite IV infusions of Labetolol, GTN and Etomidate her BP remained high. She had a very high blood cortisol measuring 1308. Treatment options/Results: After multidisciplinary discussion she was offered embolisation. Preoperative CT demonstrated the arterial tumour supply was from pudendal and obterator arteries. Embolisation was performed with combination of distal Interlock coils to prevent non target embolisation, 100μm Embozene and 250-355μm Contour and further proximal interlock coils. Completion angiograms showed an excellent result with a very small residual area of tumour supplied by a branch of the suprior gluteal which could not be cannulated. Discussion: Post embolisation her BP rapidly dropped requiring only a single low dose oral antihypertensive. Her cortisol rapidly reduced to 100. She went on to have complex pelvic fixation. This case demonstrates the use of embolisation in an rare case of ACC and hypertensive crisis. Embolisation was performed to primarily reduce tumour hormone secretion rather than to recude tumour size. Take-home points: ACC is a rare tumour that can result in hormonal syndromes including Cushing's syndrome and hypertensive crisis. Emolisation can be offered to reduce hormone secretion and treat a hypertensive crisis.

European Conference on Interventional Oncology

P-47, P-49

P-42, P-64

P-42, P-64

701.2, P-2, P-31, P-85

P-42, P-64

P-42, P-64

P-4, P-94

P-47, P-49

P-42, P-64

P-4, P-94

European Conference on Interventional Oncology Author Index Li Jia. P-13

P-4, P-94

P-39, P-81

1 Vascular and Interventional Radiology, Guy's and St Thomas' Hospital, NHS Foundation Trust, London, GB, 2 Guy's and St Thomas' Hospital, NHS Foundation Trust, London, GB, 8 Clinical Research, Cardiovascular and Interventional Radiological Society of Europe, Vienna, AT, 9 Servicio de Radiodiagnóstico, Hospital Clínic de Barcelona, Barcelona, ES 

High-intensity focused ultrasound for prostate cancer treatment: long-term follow-up of 1320 patients V. Solovov, A. Tiurin Interventional Radiology, Samara Oncology Center, Samara, RU Purpose: To analyze long-term results of the HIFU treatment of patients with different stages of prostate cancer (PC) including localized PC, locally-advanced PC, and failure after external beam radiotherapy (EBRT) and radical prostatectomy (RPE). Material and methods: The current analysis included the results of treatment of 1320 patients in the Samara Oncology Center between 2007 -2021: 768 with localized PC, 498 with locally-advanced PC, 54 -after the EBRT and RPE failure. Mean follow-up is 124 months (range 6-164). The oncology followup consisted of the PSA evaluation, the MRI and a transrectal biopsy in the case of rising the PSA. Results: In group with localized PC after 14 years of follow-up the progression was observed in 5.9 % of the patients; in group with locally-advanced PC in 36.7 % of the patients; in group with EBRT and RPE failure in 19.2 %. The local recurrence was diagnosed after in average of 12 (6-18) months after the initial treatment. 15 (1.1 %) patients needed to undergo a second treatment due to a local recurrence. Conclusion: The HIFU ablation is a safe, minimally invasive treatment for a localized and a locally advanced prostate cancer, effective in 85.9 % of the cases.

Transarterial management of locally advanced breast cancer using spherical embolic material S. Hori, T. Nakamura, A. Hori, I. Dejima, N. Kennoki, S. Oka Radiology, Institute for Image Guided Therapy, Izumisano, JP Purpose: Locally advanced breast cancer (LABA) is mainly treated with systemic chemotherapy, however, the prognosis is poor. We have conducted transarterial treatment for LABA with TACE method. The purpose of this study is to confirm the clinical value of transarterial management of LABC. Material and methods: A total of 27 previously untreated patients with LABC in stage III or IV were evaluated retrospectively. A microcatheter was advanced selective to the all branches to the breast tumor. Drug distribution was confirmed by CT during selective angiography. After infusion of anticancer drugs to target lesions, embolization was done by HepaSphere. Axillary lymph node metastases were also treated with the same manner. Treatment was repeated on demand. The primary endpoint was tumor reduction rate in 1,3,6,12 months after initial therapy. The secondary endpoint was overall survival. Results: Average reduction rates in 1,3,6,12 month were, 33%, 55%, 60%, 61%, respectively. The adverse events which needed any therapy were not found. No additional treatment was necessary to control symptoms after TACE. Local pain, bleeding or infection were well controlled. The survival rates in 1 year and 2 years were 80.4% and 68.1%, respectively. Conclusion: TACE for LABC is feasible and effective to reduce the size of breast tumor with less complication, consequently, prolongs patient life maintaining better QOL.PET/CT the adenopathic component had disappeared. However, an IVC thrombus with high SUV was observed (Image 1). Multidisciplinary tumor board reccommended to perform a biopsy of the lesion. Treatment options/Results: A percutanous intravascular biopsy of the IVC lesion was performed using a 10-French sheath and a colonoscopy biopsy forceps (Image 2) through a transjugular approach. The histopathological report revealed a metastasic origin of the thrombus. Discussion: Intravascular metastases are a very rare form of neoplastic dissemination, especially in colorrectal cancer. This type of metastasis can be difficult to diagnose, as they can be reported as venous thrombosis because of the high frequency of deep vein thrombosis in oncologic patients. Contrastenhanced CT scan is useful to diagnose the intravascular neoplasm but a biopsy should be performed if it's technically feasible to make the histopathological diagnosis. Take-home points: This case show a very rare form of neoplastic dissemination (Intravascular metastasis) in a frequent type of tumor (colorectal cancer). Transjugular approach for percutaneous biopsy using a colonoscopy forceps can be a useful and safe method of obtaining histological samples in the case of intravascular lesions.

Carotid body tumor: a multidisciplinary approach and the important role of preoperative embolization G. della Malva 1 , A. Giammarino 1 , D. Pascali 1 , A. Palmieri 2 , F.M. Fiore 2 , M. Amato 3 , M. Caulo 1 1 Department of Neuroscience, Imaging and Clinical Sciences, ''G. d'Annunzio'' University, "SS. Annunziata" Hospital, Chieti, IT, 2 Vascular and Endovascular Surgery Unit, "G. d'Annunzio" University, "SS. Annunziata" Hospital, Chieti, IT, 3 U.O.C. of Radiology, Vasto, "San Pio" Hospital, Vasto, IT Clinical history/Pre-treatment imaging: 68-year-old man with bulky mass left neck, asymptomatic, has referred for surgical evalutation. The computed tomography angiography (CTA) showed a soft tissue density mass (4.2x4x6.5 cm), located at the bifurcation of the left carotid artery and characterized by a homogeneous contrasting impregnation. The 3D TOF MR angiographic demonstrating enlargement of the external (ECA) and internal (ICA) carotid artery but not narrowing of the ICA and ECA. These with CT and MRI are compatible with a type III CBT (Carotid Body Tumor) according to the Shamblin classification. Treatment options/Results: The patient underwent preoperative endovascular embolization. After selective catheterization of the external and internal carotid branches, the lesion is then embolized by inert polyethylene glycol (PEG) microspheres (HydroPearl 1 fl of 400±75 μm and 3 fl of 600±75 μm). The patient successfully underwent excision of the lesion via cervicotomy within a week from the embolization procedure, without any complication and discharged a few days after surgery. Discussion: The CBT are the most common type of paraganglioma in the head and neck region. When classified as Shambin type III, it may require preoperative CBT embolization. PGE microspheres exhibit variable vessel

A. Borzelli, F. Amodio, F. Giurazza, F. Pane, E. Cavaglià, F. Corvino, M. Silvestre, R. Niola AORN "A.Cardarelli", UOC Radiologia Vascolare ed Interventistica, Napoli, IT Learning Objectives: Evaluate the role of contrast-enhanced ultrasound (CEUS) as a powerful tool and aid to better identify and define soft tissue tumours in abdominal cavity, otherwise not detactable by Duplex B-mode US,to allow their safer percutaneous biopsy. Background: 12 patients(medium age 57 years-old,5 M 7 F) with radiological (TC/RM)diagnosis of focal liver lesions(7),focal lesions of the cephalic portion of pancreas(3)and malignant recurrence after duodenum-pancreatectomy in pancreatic loggia(2),have been retrospectively considered between January 2020 and december 2020.In all cases the identification of the target lesion by Duplex B-mode US was not possible and CE-US(Sonovue,sulfur hexafluoride)was employed to better delineate them and finalise their percutaneous biopsy. We considered an arterial phase(20-25 sec)and a venous phase (60-90 sec)to identify them.In all cases a 18 G vacuum-assisted needle was used. Clinical Findings/Procedure Details: Technical success was achieved in all (12) patients and in all cases the target lesion was identified with more accuracy and the percutaneous biopsy allowed with more precision and safety. In all patients 2 samples were taken and the confirmation of diagnostic biologic material came from the histologic corroboration. In none of the cases the samplig was not possible and in none of the cases major complications such as bleeding or haemorrhage due to injury to abdominal parenchymas or great vessels occurred. Conclusion: The elevated rate of techical success reported,the absence of major complications and the faster performance,confirm the added value of CEUS as advantageous tool to better identify and delineate abdominal soft tissue focal lesions not detactable by Duplex US to allow their safer and faster percutaneous biopsy. Purpose: Microwave-Assisted Chemical Ablation (MACA) is a novel technology aiming to broaden the range of microwave ablation (MWA) applications by increasing the diseased tissue ablation zone size and improving its predictability, thus reducing collateral damages to healthy tissues. This preliminary study is to validate the technology and to quantify its efficiency and precision benefits through the performance of numerous ex vivo bovine liver tissues experiments. Material and methods: Bovine liver was used for the experimental ablative procedures. A prototype MWA antenna equipped with an additional internal lumens was connected to a current production microwave generator and was used to dispense ethanol as a chemical ablation agent simultaneously to the emission of the microwave energy. Various parameters including conventional ones such as power over time were applied as well as MACA-specific ones such as volume of ethanol dispensed and ethanol elution rate were assessed. The evolution of the temperature at various locations surrounding the emission point as well as applied and reflected power were monitored over time as the ablation proceeded. The resulting ablation zones were characterized from dimensions measurements, colours and texture of the necrosed tissues. Results: The procedures carried out using this Microwave-Assisted Chemical Ablation (MACA) technology were characterized by significant benefits such as reduced maximal temperature reached, reduced procedure time, larger ablation zones, more predictable ablation zone shape, and reduced collateral damages to healthy tissues. Conclusion: This novel Microwave-Assisted Chemical Ablation (MACA) technology is a promising new tool for the Interventional Oncology. Purpose: High-intensity focused ultrasound (HIFU) provides an alternative treatment for malignant tumours, with magnetic resonance imaging (MRI) and ultrasound used for monitoring during treatment. A MRI guided robotic system for HIFU treatment of prostate cancer was developed, featuring motion in 5 degrees of freedom and equipped with a single element focused ultrasonic transducer. Material and methods: The robotic device was assessed successfully for its MRI compatibility inside a 1.5 T scanner using three different imaging sequences. The performance of the transducer has been evaluated in a laboratory and MRI environment, on ex vivo porcine loin tissue as well as in vivo thigh tissue using a rabbit model, for its ability to create discrete lesions. MR thermometry data were acquired during sonications providing visualization of the rate of increase of temperature. Results: In ex vivo porcine tissue, the transducer created tadpole shaped lesions indicating possible cavitational effect during formation, while in cases that probably no bubbles existed in the tissue, thermal lesions were created. The in vivo experiments demonstrated the ability of the device in achieving in situ necrosis without havoc in surrounding areas nor the occurrence of adverse effects thereby not compromising animal welfare. Conclusion: The MRI compatibility of the system enables its placement on the table of commercial MRI scanners, of any manufacturer, up to 7 T. The ultrasonic transducer is coupled to a probe which can be placed transrectally, with the patient placed in supine position on the MRI table. The proposed robotic system can be utilised in the future for the transrectal focal treatment of prostate cancer.

The Purpose: The COVID-19 pandemic had an unprecedented impact on clinical practice and healthcare professionals. We aimed to assess how the interventional radiology (IR) services were impacted by COVID-19. Material and methods: 7125 CIRSE members were invited to participate. The survey was designed to assess changes in workflow and clinical management patterns. For this interim report, responses were collected between 17 December 2020 and 4 January 2021. Results: 151 responses were obtained for this preliminary report, of which 92 were complete. 83.1% (n=98) of respondents were male and board-certified radiologists (42.4%; n=50) Most respondents reported to have been involved in the care of Covid-19 positive patients (83.9%; n=99). 36.4% (n=36) reported that the second wave starting in September was the most intense and stressful period of the pandemic, while 33.3% thought this was the case for the first wave and 27,3% reported that both waves were similar in intensity. The overall IR workload was reported to have remained stable (28.3%; n=30), mildly decreased (26.4%; n=28) or decreased a lot (22.6%; n=24). Regarding work patterns, both interventionalists and associated staff (nurses, technicians) were reported to be more frequently redeployed during the second wave (44.4% and 77.8%, respectively) than during the first wave (13.5% and 41%, respectively). Conclusion: Interventional radiology services could not have stayed unaffected by the unprecedented health crisis that COVID 19 brought. As the second wave still evolves, we continue to collect responses aiming to develop a better understanding regarding the true impact of the pandemic on IR services and staff.

Quantitative ablation margins for assessment of ablation completeness in thermal ablation of liver tumours R. Sandu 1 , I. Paolucci 1 , S.J.S. Ruiter 2 , R. Sznitman 1 , K.P. de Jong 2 , J. Freedman 3 , S. Weber 1 , P. Purpose: Complete coverage of the tumour by the ablation volume with a sufficient ablation margin is the most important factor for treatment success in thermal ablation of liver tumours. To date, ablation completeness is commonly evaluated by visual inspection in 2D and is prone to interreader variability. This work aimed to introduce a standardized algorithm for evaluation of the ablation margin after CT-guided thermal ablation of liver tumours, using volumetric quantitative ablation margins (QAM). Material and methods: A QAM computation metric was developed based on segmentations of tumour and ablation volumes. The QAM metric is calculated using signed Euclidean surface distance maps with a novel algorithm to address QAM computation in subcapsular tumours. The code was verified in artificial examples of tumour and ablation spheres simulating varying scenarios of ablation margins. Applicability of the QAM metric was verified in a cohort of colorectal liver metastases treated with stereotactic microwave ablation. Results: The applicability of the algorithm was confirmed in synthesized and clinical examples. An underestimation of tumour coverage by the ablation volume was confirmed when applying an unadjusted QAM method in subcapsular tumours. The code for the developed QAM algorithm was made publicly available, encouraging the use of this objective metric in reporting ablation completeness and margins. Conclusion: The proposed QAM computation including a novel algorithm to address subcapsular liver tumours enables precision and reproducibility in the assessment of ablation margins. This quantitative feedback on ablation completeness opens possibilities for intra-operative decision making, refined analyses on predictability and consistency in the reporting of ablation margins.CT guidance, drain connected to a digital drainage system (pressure and air leak values every 10 minutes) and suction at -20mmHg. All patients with drainage at least 24 hours, then removed according to air leak data and CT scan. Collection of data from digital device after drain removal (time to reach air leak of 20mL/min, time to reach autonomous pleural pressure regulation (APPR), recurrence of air leak, time between air leak resorption and APPR, theoretical minimum drainage time according to surgical experience (air leak under 20 ml/min for 6 hours), concerning patients and interventions. A control chest scan within one month after removal of the drain. Results: 50 patients were retrospectively included ( 15 lung biopsies, 10 RFA, 25 cryoablations). Mean age was 62 years (13), mean number of lung path was 2.28 (1.05), 3 patients with a history of ipsilateral lung surgey. Mean time to reach air leak of 20mL/min was 150 minutes (376), time to reach APPR was 217 minutes (382). Theoretical minimum drainage time was 6.5 hours or less for 70% of the patients. Conclusion: Monitoring air leakage and pleural pressure can improve the management of pneumothorax drainage in interventional radiology.

An x-ray lead screen may be used to reduce an interventional radiologist's radiation exposure during CT-guided procedures G. Rosiak, J. Podgorska, K. Milczarek, D. Konecki, O. Rowinski Radiology, Warsaw Medical University Hospital, Warsaw, PL Purpose: The exposure of both patient and operator to radiation is one of the limitations of CT-guided interventions and should be kept as low as reasonably possible. While various x-ray lead screens are frequently used in angiography suites, they have not gained popularity in relation to CT-guided procedures. The purpose of this study was to evaluate the efficacy of a lead screen in reducing the radiation dose to an operator during CT-guided interventions. Material and methods: This prospective study analyzed data collected from 72 consecutive CT-guided procedures, all of which were performed with an x-ray protecting lead screen placed between the scanner and the operator. Five dosimeters were placed in the CT scanning room: on the scanner side of the screen (1), on the operator side of the screen (2), 2 meters (3) or 3 meters (5) from the gantry, and at the side of the gantry (4). Accumulated radiation doses were measured for each dosimeter. Results: The dosimeter placed on the gantry side of the lead screen revealed highest levels of radiation (11.33 mSv), which were significantly higher than those at all other dosimeters. The radiation dose just behind the lead screen was 0.82 mSv which was almost as low as measured by dosimeters 2 meters away from the gantry at the side of CT scanner (0.83 mSv). The presence of the screen caused no discomfort for operators. Conclusion: A lead screen does reduce an operator's radiation exposure significantly, while failing to pose any obstacles or cause any discomfort as CT-guided procedures are being carried out.

Oncologic surgical resection with intravascular covered stent placement in patients with carotid artery encased by metastatic cancer K. Liu 1 , Z. Yu 2 1 School of Medicine, Southeast University, Nanjing, CN, 2 Department of Otolaryngology Head and Neck Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, CN Purpose: Tumor encasement of the common carotid artery (CCA) and/or the internal carotid artery (ICA) in patients with advanced head and neck tumors represents a significant surgical challenge. Material and methods: Five patients with advanced head and neck squamous cell carcinoma (AHNSCC) invading one side of the carotid artery were retrospectively enrolled. The contrastenhanced computed Tomography (CT) and angiography were performed to assess the severity of extrinsic tumor compression to the carotid artery. Covered stent was placed intra-arterially at least 1 cm proximal and distal beyond the area of tumor involvement. The tumor and the involved carotid artery were resected, and pectoralis major flap transfer was utilized for coverage of the great vessels supported with intraarterial covered stent.

The post-stenting demonstrated an improvement in the appearance and caliber of the affected carotid artery. Four patients experienced transient bradycardia and hypotension. All five patients underwent R0 resection. Postoperatively, the flap all had rich vascularity and healing. Three patients underwent adjuvant radiotherapy or chemoradiation. With median follow-up 6.5 months, one patient died of multiple organ failures at 6.5 months after surgery; one patient developed tracheal stoma recurrence and treated with salvaged surgery; the three other patients had no disease recurrence in their last follow-ups. Conclusion: Surgical resection with intravascular covered stent placement could potentially achieve the maximal oncological resection without compromise carotid artery blood flow in patients with carotid artery encased head and neck cancer.

Monitoring air leakage and pleural pressure during Posters to the emission of the microwave energy. Ethanol is an example of chemical ablation agent that can be selected as it possesses the dielectric and thermal properties to effect a good control over the electrical field and the resulting evolution of the ablative procedures over time. The same lumens can be used post-ablation treatment to dispense materials to reduce pain, accelerate healing time, or boost the immune system recovery. Bovine liver was used for the experimental ablative procedures. Results: The procedures carried out using this Microwave-Assisted Chemical Ablation technology were characterized by significant benefits such as reduced maximal temperature reached, reduced procedure time, larger ablation zones, more predictable ablation zone shape, and reduced collateral damages to healthy tissues. These benefits offer significant potential for broadening the range of microwave ablation (MWA) applications compared to current practice. • To present a diffent technique based in Seldinger exchanges that reduces the risk and shortens the duration, using a 4 or 5 F radial sheath. • To explain thoroughly the steps of this unusual procedure. Background: Microwave and radiofrequency percutáneas tumor ablation are common and well known procedures performed in the majority of interventional radiology units. The procedure is done with anaesthesiologist assistance and CT or ultrasound guidance. Local anasthetic is administered in the skin and soft tissues, allowing planning the direction and angle of approaching. This aims achieving a successful puncturing of the target lesion with a small size needle, minimizing the possibility of seeding tumoral cells, unintentional puncturing of adjacent structures with a thicker needle or major bleeding. Clinical Findings/Procedure Details: In our institution we came out with a method that goals avoiding these same issues in a safer manner. Firstly, local anaesthetic is applied as conventional procedure. After that, a 21 gauged Chiba coaxial needle is advanced until it reaches the tumor. Then we easily detach the inner needle back handle, retrieve the outer coaxial part and place a 4 o 5 F radial sheath through the needle. Both the needle and the inner part of the sheath are retrieved. Eventually the ablation needle passes through the sheath towards the tumor. Conclusion: Co-axial technique is a safe procedure to place RF or MW device in the middle of the tumor lesion Controlling these parameters to maximize the potential for broadening the range of microwave ablation (MWA) applications by increasing the diseased tissue ablation zone size and improving its predictability, thus reducing collateral damages to healthy tissues. Material and methods: Numerous computer-assisted numerical models were obtained using a commercial 3D electromagnetic (EM) simulation software. The parameters forming the basis of the calculations included the dielectric conditions that are present when a microwave source is applied while connected to an ablation antenna equipped with an additional lumens to dispense a chemical ablation agent into the target tissues simultaneously to the emission of the microwave energy. Ethanol was used as chemical ablation agent because it possesses the dielectric and thermal properties to effect a good control over the electrical field and the resulting evolution of the ablative procedures over time. Bovine liver was used for the target medium. Similar models were calculated using typical microwave ablation equipment currently used for microwave ablation procedures (MWA). Results: The models calculated with the Microwave-Assisted Chemical Ablation-specific parameters showed significant benefits in terms of increased ablation zone size and ablation zone shape predictability. Conclusion: The models calculated with the Microwave-Assisted Chemical Ablation-specific parameters suggest that a judicious control over these parameters will lead to highly efficient ablation procedures and predictable ablation zones when compared to MWA as currently practiced.

Microwave 

Interventional radiology services in COVID-19 patients: a single center experience I. Thanou, K. Tavernaraki, P. Filippousis, S. Arapostathi, N. Sidiropoulou, E. Gerardos, L. Thanos Imaging and Interventional Radiology, Sotiria General Hospital of Athens, Athens, GR Learning Objectives: To demonstrate our experience regarding strategies and detailed processes evolved after the pandemic outbreak in the management of COVID-19 patients whilst performing necessary interventional procedures. Background: As SARS-COV2 remains a fluid situation, our institution has been the greatest in our country to hospitalize COVID-19 patients. In a minority of our COVID-19 / suspected COVID-19 patients did emerge the need of an urgent interventional procedure. Therefore, a crucial goal to be achieved was to adapt our services (both diagnostic and interventional) to combat COVID-19. Adoption of finalized protocols in accordance to ECDC and CIRSE guidelines has been followed in order to avoid disease spread and facilitate both patients' and involved personels' safety. Clinical Findings/Procedure Details: Steps to avoid disease spread: 1. Separate CT room with a private material storage room and isolated hallways for COVID-19 patients. 2. MDT to confirm procedure's urgent nature (avoid non-essential procedures). 3. Bedside ultrasound-guided procedures to be preferred, when applicable. 4. Thorough training of involved personel in the use of all Personal Infection Prevention Mesasures (full PPE intraprocedurally, disinfection measures postprocedurally etc). 5. Reduce staff participation to minimum (radiographer, interventional radiologists, fully-trained nurse). The majority of interventional procedures were effusion & abscess drainages, cholecystostomies, and few biopsies. All procedures were characterized by technical success and no major or minor complications have been noticed. Involved staff remained negative in repetitive SARS-COV2 testing so far. Conclusion: As pandemic remains uncontrolled, developing of protocols in IR units is essential, in order to adapt operational processes rapidly and fascilitate both patient's and staff safety.