CIRSE 2023: Non-Vascular IR

November 8, 2023

CIRSE 2023 offered a plethora of interesting options focusing on non-vascular topics in interventional radiology. From lymphatics to vertebroplasty to biliary interventions and special considerations for interventions in children, this track covered a lot of ground. All non-vascular lectures continue to be available via the CIRSE Library!

Paediatric non-vascular interventions

Paediatric interventions were in the spotlight throughout 2023, and this was very clear in the non-vascular track, which featured three sessions on treatments for IR’s smallest patients.

A focus session on hepatobiliary interventions in children contained lectures on liver biopsies, biliary interventions, portal hypertension, and hepatic vascular malformations, all followed by an informative Q&A session. All lectures placed emphasis on the fact that, while these particular interventions are broadly similar in children as they are in adults, there are a few special considerations to take for children. For example, for TJLB in children, it’s important to carefully asses the size of the liver, hepatic veins and gallbladder position, the jugular vein puncture should be performed under US guidance with a paediatric micropuncture set, and samples must be obtained from the proximal/middle third of the hepatic vein to avoid the risk of transcapsular puncture.

A fundamental course on percutaneous interventions in children also took place. This session honed in on specific cases of biopsies, urinary interventions, GI interventions, and also contained a primer lecture from N. Tahir that covered specificities in paediatric IR.  “Many of the procedures that are done in adult IR are applicable in children.” He stated. “However, there remain inequalities in practice.” He spoke on designing safe IR suites for children, key factors of sedation and anaesthesia in children, and how to think outside of the box for paediatric interventions.

A second non-vascular paediatric focus session centred on stents in children. Lectures specifically covered stenting in arteries, veins, and biliary tracts. Of note, A. Cahill, who stated that she is generally reluctant to use stents, presented on the perspectives of biodegradable stents in children. “It’s not for prime time, but we’re getting there!” She walked attendees through the pleasantly surprising amount of data available on the subject as well as the potential challenges and limitations in using these devices in children – pertinently, that bioabsorbable stents need to be thicker as the polymer is softer, and this requires a bigger delivery device.

Non-vascular EBIR preparation

The non-vascular track included four sessions which were specifically recommended for those preparing for the EBIR.

The first of these recommended sessions was a focus session on complex biliary interventions. Topics covered here included cone-beam CT in biliary interventions, biliary stenting in malignancy, tools of the trad, and how to manage post-operative biliary compilations.

A second recommended focus session from the non-vascular track honed in on the challenges of lymphatic interventions in 2023. This session walked attendees from start to finish of the intervention, starting with what clinicians need to know about the anatomy and pathophysiology of the lymphatic system, as well as how to identify and interpret flow as a prerequisite for effective treatment. The session concluded with one lecture each on the treatment of post-operative and non-iatrogenic lymphatic leakages.

A workshop on GI tract interventions included a presentation on gastrostomy and gastrojejunostomy from M. Martins de Sousa, as well as one on GI stenting from T. Sabharwal. Workshops are longer format presentations, wherein presenters have a greater amount of time to get into specific case examples and explanations.

The last EBIR-recommended non-vascular session was a hot topic symposium called “Vertebroplasty in 2023.” W. Clark opened the session with an analysis of several sham trials and the recent Cochrane review, which found no evidence favouring vertebroplasty in any patient group, but, according to Clark, contained serious methodologic problems which he believes were used to conceal the positive benefits of early vertebroplasty. X. Buy continued to try to answer if vertebroplasty is ‘still alive’ after the Cochrane review – his conclusion is yes! R. Cazzato then spoke on the impact of vertebroplasty on morbidity and mortality, and S. Tutton closed out the session with a lecture enticingly titled “New vertebral fractures post vertebral augmentation: truth or dare?”