What's Now... What's Next?
Whether in my practice at Miami Cardiac & Vascular Institute, my role as Chief Medical Editor of Endovascular Today, or working with the steering committees of ISET, SIR, and other global education experiences, one of the vascular topics that continues to stand out in terms of its progress and momentum is embolization.
The increasing variety and utility of our material armamentarium along with better capabilities in imaging, access, and delivery have dramatically enhanced our results in the kinds of cases we have been working on for years. Combined with better understanding based on the continued publication of both short- and long-term results, embolization is firmly entrenched in our daily practices.
And yet, despite this progress, it feels like we are just beginning to scratch the surface of embolization’s potential. Joining the headlines that herald improved results in existing indications are optimistic early outcomes in entirely new applications, including benign prostatic hyperplasia (BPH), osteoarthritic pain management, bariatrics, and hemorrhoids, to name just a few.
In this edition of Endovascular Today, we’ve asked a group of experts from around the world to help us illustrate this spectrum of progress, describing the current state of a handful of embolization applications, old and new.
To open our feature, Sandeep Bagla, MD, addresses one of today’s most talked about embolization applications— prostatic artery embolization for the relief of BPH. Dr. Bagla speaks to the early global experiences and his own recent study, as well as the further research that should be undertaken in order to further validate this option.
Next, Yuji Okuno, MD, shares the results of several studies his group has underway in the field of osteoarthritis and other musculoskeletal pain management. As the author notes, these applications require further testing in large-scale randomized trials, but the initial results are encouraging and certainly intriguing.
David Liu, MD, sat down with our editors to bring us up to speed on the latest selective internal radiation therapy using Y-90 particles. In this interview, one of the world’s foremost experts in radioembolic oncology discusses everything from data, training, safety, and room prep to procedural decision making and follow-up. Dr. Liu also provides his recommended reading list for those interested in becoming familiar with the Y-90 canon.
My good friend and colleague, Dr. Claudio Schönholz, and his talented team of Marcelo Guimaraes, MD, and Ricardo Yamada, MD, provide a thorough primer on the occurrence of endoleak after endovascular aortic aneurysm repair and also describe the treatment options illustrated by case examples.
Addressing another relatively new embolization research endeavor, Prof. Vincent Vidal offers a brief history and current directions of the study of embolization for hemorrhoid symptom relief, the “Emborrhoid” technique. Prof. Vidal discusses the limitations of other therapies, describes the technique in detail, and provides a look at the research that is underway.
We conclude our focus on embolization with a feature in which we ask three physicians who are each experienced with a variety of embolic materials and devices to give their wish lists on what the next generation of coils should offer. Be sure to check out what Drs. Lorenzo Moramarco, Parag Patel, and Ripal Gandhi would each like to see.
In addition to the embolization coverage, we also have the conclusion of a three-part series on cerebral AVMs, the benefit of coding expert Dr. Kathy Krol’s keen eye on what we should all be prepared for when ICD-10 is implemented, and Primacea’s experiences in navigating the Open Payments system. Our issue concludes with an interview with Tara M. Mastracci, MD, who recently left the Cleveland Clinic to practice her top-notch interventional and surgical aortic skills in London.
We hope you enjoy this showcase of some of the latest advances in embolization.
Barry T. Katzen, MD
Chief Medical Editor