RPS 2109 - Plug, block, heal: the art and science of embolotherapy

Author Block: C. Viola, F. C. Bodini, M. Graffeo, C. Sallemi; Brescia/IT
Purpose: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, and transarterial embolization is the standard treatment for intermediate-stage disease. While conventional transarterial chemoembolization (TACE) is widely used, the added value of chemotherapy over bland embolization remains debated, with concerns about increased toxicity and costs. In large tumors, particle-based embolization may result in incomplete coverage, leaving viable tumor tissue. Ethylene-vinyl-alcohol-copolymer (EVOH) is a non-adhesive liquid embolic agent with controlled, progressive delivery that provides durable and uniform vasculature filling. The TAEVOH study aimed to evaluate the feasibility, safety, and oncological outcomes of EVOH embolization in clinical practice.
Methods or Background: This retrospective single-center study included consecutive patients with unresectable HCC treated with EVOH embolization between 2020 and 2025. Eligible patients had BCLC B disease, no portal vein thrombosis or extrahepatic spread, and Child-Pugh A–B liver function. Procedures were performed under conscious sedation with selective or superselective microcatheterization and controlled EVOH injection until complete tumor filling. Primary endpoints were radiologic response (mRECIST) and safety (CIRSE/CTCAE v5.0). Secondary endpoints included AFP reduction and downstaging to curative treatment.
Results or Findings: Forty patients (median age 78 years, 56% male, Child-Pugh A in 82% and B in 18%) underwent 52 procedures with 100% technical success. At first imaging assessment, complete response was observed in 8 of 27 evaluable patients (30%). AFP decreased by >50% in evaluable patients. Eight patients (27%) achieved downstaging and underwent curative therapies. Minor adverse events were limited to post-embolization syndrome and transient grade 1–2 hepatic toxicity, without major complications.
Conclusion: EVOH embolization is a feasible, safe, and effective treatment for unresectable HCC, with encouraging radiologic response and downstaging rates. Prospective studies are warranted to validate these results.
Limitations: Retrospective, single-center design with a limited cohort; long-term follow-up is ongoing.
Funding for this study: No external funding was received for the completion of this study
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Approved by the Territorial Ethics Committee Lombardia 6 (Pavia, Italy), session of July 29, 2025 (Protocol No. TAEVOH-1, Prot. 0045956/25)

Author Block: M. Serenari¹, F. Ratti², M. Cescon¹, G. Ercolani³, V. Mazzaferro², D. Patrono⁴, E. Jovine¹, C. Mosconi¹, F. De Cobelli²; ¹Bologna/IT, ²Milan/IT, ³Forli/IT, ⁴Torino/IT
Purpose: To present multicentre real-world data on safety and efficacy of liver hypertrophy-inducing procedures (HIP) aiming to track trends in these approaches in Italy, and support a collaborative multidisciplinary network to reinforce the fundamental synergy between surgeons and radiologists.
Methods or Background: The I GROWtoH registry prospectively collects data on HIPs performed in candidates for major hepatectomy. For this analysis, the retrospective cohort (Jan 2014–Sep 2024) was reviewed. Demographics, indication for surgery, type of hypertrophy technique, imaging-based functional/volumetric assessment and peri-procedural outcomes were analysed.
Results or Findings: A total of 464 patients from 17 centres were included: 169 colorectal liver metastases (36.4%), 97 intrahepatic cholangiocarcinoma (20.9%), 91 perihilar cholangiocarcinoma (19.6%), and 77 hepatocellular carcinoma (16.6%). HIPs performed comprised 224 portal vein embolisations (48.3%; 8% including segment 4), 73 portal vein ligations (15.7%), 44 double vein embolisations/liver venous deprivations (9.5%) and 5 radiation lobectomies (1.1%). Complications occurred in only 3 patients after DVE/LVD. Hepatobiliary scintigraphy was performed in 105 patients after HIP (22.6%) while median increase of future liver remnant volume was 43% (IQR 30–66). Overall, 353 patients (76.1%) underwent curative major hepatectomy; 90-day mortality after HIPs was 5.0%.
Conclusion: Curative hepatectomy was achieved in over three-quarters of patients, underscoring the role of these procedures in expanding surgical options for complex hepatobiliary malignancies and witnessing the need for a shift from a “surgical-based” management to a multidisciplinary approach (from definition of surgical candidates, to choice of hypertrophy techniques, to management of intra and postoperative challenges). This trend reflects the collective effort of the Italian surgical community to build consensus on key aspects of regenerative liver surgery, laying the groundwork for a stable and synergic collaboration between surgeons and radiologists.
Limitations: Retrospective design and heterogeneity of techniques across centres.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: CE AVEC 450/2024/Oss/AOUBo

Author Block: D. Laczko, B. Nemes; Budapest/HU
Purpose: Bronchial artery embolization effectively treats severe and recurrent hemoptysis and dramatically reduces mortality rates from 80-90% to less than 10%. Despite its success, no previous meta-analysis has focused on comparing the effectiveness and safety of particle and liquid embolic agents. This study aims to address this gap by comparing the effectiveness and safety of these available embolic agents.
Methods or Background: : We systematically searched MEDLINE, EMBASE, CENTRAL, Scopus, and Web of Science for relevant studies from inception until November 02, 2023. Eligible studies included cohort studies of patients who were treated with either particle or liquid embolic agents. The technical and clinical success, hemoptysis recurrence rates were meta-analyzed. Risk of bias was assessed using MINORS. Forest plots visualized meta-analytical results. The study was registered with PROSPERO (CRD42023480289).
Results or Findings: Of 2,502 studies, 59 met the inclusion criteria, including 4,660 patients. No significant difference between particle and liquid agents was observed in the proportion of immediate clinical success (0.95 vs 0.95, p=0.935). The proportion of 12-month hemoptysis recurrence did not differ between particle and liquid embolic agents (0.14 vs 0.17, p= 0.663). Significantly higher proportions of hemoptysis recurrence were observed between patients with malignant and non-malignant lung disease at all follow-up times (1 month: 0.26 vs 0.05; p<0.001; 3 months: 0.44 vs 0.08; p<0.001; 6 months: 0.56 vs 0.12; p<0.005; 12 months: 0.66 vs 0.11; p<0.001).
Conclusion: Our findings suggest that both particle and liquid embolic agents are effective and safe in treating hemoptysis. Patients with malignant lung diseases had shorter hemoptysis-free periods, highlighting that this subpopulation might benefit from a closer follow-up.
Limitations: The lack of reporting patient level data prevented us from conducting further analyses based on different etiologies and further exploring the high heterogeneity.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: Z. Hu; Hangzhou/CN
Purpose: To evaluate the efficacy and safety of first-line transcatheter arterial chemoembolization (TACE) combined with targeted therapy and immunotherapy in patients with stage IIb/IIIa hepatocellular carcinoma (HCC).
Methods or Background: A total of 198 patients who received first-line TACE combined with targeted immunotherapy or TACE alone from January 2015 to December 2022 were selected.
Using propensity score matching, 50 patients were included in both the combination group and the TACE-alone group(Figure 1) . Kaplan-Meier method was used to calculate the median overall survival (mOS) and median progression-free survival (mPFS) with 95% confidence interval (CI). Objective response frate (ORR) and disease control rate (DCR) were assessed based on modified Response Evaluation Criteria in Solid Tumors (mRECIST).
Results or Findings: The mOS in the combination group was 30.1 months (95% CI: 21.9-38.3) compared to 14.5 months (95% CI: 11.0-18.0) in the TACE-alone group, showing a statistically significant difference (P < 0.001). (Figure 2.)
The mPFS in the combination group was 10.3 months (95% CI: 8.8-11.8) compared to 7.1 months (95% CI: 5.8-8.4) in the TACE-alone group, with a statistically significant difference (P < 0.001).
The ORR and DCR in the combination group were 84% and 94% respectively, while in the TACE-alone group, they were 58% and 80% respectively. The differences in ORR and DCR between the two groups were statistically significant (P < 0.05).
The incidence of severe adverse events was 24% in the combination group and 16% in the TACE-alone group(P= 0.317).
Conclusion: Compared to TACE alone, TACE combined with targeted therapy and immunotherapy provides better efficacy without increasing the incidence of severe adverse events in patients with CNLC stage IIb/IIIa HCC.
Limitations: This is a retrospective study with selection bias."
Funding for this study: No funding
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: the study protocol was approved by the ethical committee of the First Affiliated Hospital of
Soochow University

Author Block: M. Duffy¹, A. Deshwal¹, R. Donnelly¹, M. J. Mullins²; ¹Dublin/IE, ²EAST FREMANTLE/AU
Purpose: To assess the rates of success, complications, and re-interventions of selective arterial embolisation of renal angiomyolipomas
Methods or Background: A systematic review and meta-analysis was conducted, including studies reporting outcomes of selective arterial embolisation for renal angiomyolipomas. Pooled estimates were calculated for technical success, radiological success, clinical success, tumour shrinkage, re-embolisation rates, surgical re-intervention, and complication rates. Heterogeneity was assessed using I² statistics. Exploratory regression modelling was performed to assess factors associated with re-intervention.
Results or Findings: Thirteen studies comprising of 478 patients and 542 AMLs were included. Technical success – successful delivery and occlusion of the embolic agent – was achieved in 86.2% of cases (95% CI: 80-89.1%; I² = 36.1%). Radiological success, based on CT-assessed tumour shrinkage, was observed in 94% of cases (95% CI:91.2-97.3%; I² = 15.6%). Subgroup analysis revealed ethanol-alone embolisation achieved the highest shrinkage (95.8%) and lowest re-intervention rate (3.4%). Pooled re-intervention (re-embolisation or surgery) was required in 19% of cases (95% CI: 10–34%; I² = 85.9%). Minor complications occurred in 46% of procedures, predominantly post-embolisation syndrome (PES, 43%; 95% CI: 35–53%, I² = 88.8%). Major complications, such as retroperitoneal bleeding, significant haematuria, abscesses or prolonged hospital admission, were rare (pooled rate: 5.7%; 95% CI: 3.9–8.2%), and the pooled rate for surgical re-intervention was 4% (95% CI: 2-7%) with low heterogeneity (I² = 9.6%, p = 0.333).
Conclusion: Embolisation is a safe primary treatment option for renal angiomyolipomas with high technical and radiologic success, low major complications, and rates of surgical intervention. Embolic agent choice significantly impacted outcomes in this cohort.
Limitations: Clinical heterogeneity reflects variable techniques, definitions, follow-up, and patient selection. Standardised prospective studies with uniform embolic protocols and eGFR tracking are needed to optimise embolisation strategies and assess long-term renal outcomes.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: L. Habiro Alves¹, G. Martin¹, A. C. Servidoni², H. Provinciatto³, G. Franceschini Machado¹, K. Miller⁴, B. Taneja⁵, A. K. Taneja⁶, A. Yousif⁷; ¹São Paulo/BR, ²New Haven, CT/US, ³Ribeirao Preto/BR, ⁴Sao Paulo/BR, ⁵Boston, MA/US, ⁶Miami, FL/US, ⁷El Paso, TX/US
Purpose: Placenta accreta spectrum disorder is a pregnancy complication associated with a substantially increased risk of maternal mortality. With the advancements of interventional radiology, uterine artery embolization has emerged as an effective minimally-invasive alternative to avoid hysterectomy for severe postpartum hemorrhage. The aim of this systematic review and meta-analysis is to evaluate whether uterine artery embolization is an effective and safe method to manage post-partum hemorrhage associated with placenta accreta spectrum.
Methods or Background: PubMed, Embase, and Cochrane Central were systematically searched for studies published from inception until September 2025. A random-effects meta-analysis was conducted through RStudio version 4.4.1 to pool prevalences and rates. The Cochrane Collaboration’s Risk Of Bias In Non-randomized Studies of Interventions tool was used for quality assessment.
Results or Findings: Six studies including 215 participants were analyzed. The pooled clinical success rate of uterine artery embolization was 85.0% (95% CI, 77.7–90.2), while the pooled prevalence of hysterectomy after clinical failure was 7.9% (95% CI, 4.9–12.5). Postoperative complications occurred in 19.0% of cases (95% CI, 6.2–45.5) and the pooled mean estimated blood loss was 1825 mL (95% CI, 1116–2533).
Conclusion: Uterine artery embolization is an effective and safe interventional radiology strategy for PPH due to placenta accreta, offering high success rates while preserving uterine function and reducing surgical morbidity.
Limitations: First, there are no published randomized controlled trials on management of PHH secondary to PAS, which restricts the number of studies evaluated and overall statistical power. Second, long-term maternal outcomes, such as subsequent fertility and menstrual function, were not consistently reported, limiting the ability to assess the broader safety profile.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: T. J. Vogl, B. Fischer, T. Gruber-Rouh, H. Adwan; Frankfurt/DE
Purpose: To evaluate unresectable lung metastases of different primary lesions and primary lung cancers treated by transpulmonary chemoperfusion (TPCP) or transpulmonary chemoembolization (TPCE) regarding size and ADC-values.
Methods or Background: In this prospective randomized study 60 patients (30 women, 30 men; mean: 64.5y; range: 29-84y) were included who were treated by TPCP (n=30) and TPCE (n=30). Malignant lesions were from primary lung cancers (n=15), colorectal (n=13), breast cancer (n=10), and other primaries (n=22). All patients were treated via a transfemoral venous approach selectively into the segmental pulmonary artery using Cisplatin and MitomycinC. The TPCE patients received additionally EmboCept®S for the embolization. Follow-up was performed using MRT and CT in 3-month intervals post final therapy session.
Results or Findings: No major side effects were observed. In the TPCE group, mean value in the change of volume was 0.97±0.54, in the TPCP group 1.43±1.14 (p=0.08). Change of the ADC-value was 1.08±0.33 in TPCE and 1.13±0.50 in TPCP (p=0.7). According to RECIST 1.1, TPCE patients showed partial response (PR) in 4 cases and progressive disease (PD) in 4 cases (PR=14.81%, PD=14.81%). The TPCP group showed 1 case of PR and six cases of PD (PR=3.57%, PD=21.43%). The overall survival time in the TPCE group was 732.70±379.41 days, in the TPCP group 552.82±350.23 days (p=0.09). The progression-free time had a p-value of 0.14 (TPCP: 405.36±324.37 days; TPCE: 554.07±397.49 days)
Conclusion: TPCP and TPCE can be safely performed. TPCE resulted in a more stable treatment outcome and a better prognostic trend than TPCP, even though there was no statistically significant difference between TPCP and TPCE concerning overall survival.
Limitations: The number of study participants for each group was very limited.
The groups were not as homogeneous as a statistical evaluation of small groups requires.
Funding for this study: No funding
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: By the Ethics Committee of the university hospital

Author Block: J. Pereira, L. A. Ferreira, B. Oliveiros, P. Donato; Coimbra/PT
Purpose: To compare different embolic agents' efficacy in the treatment of spontaneous soft tissue haemorrhage in anticoagulated patients.
Methods or Background: Spontaneous soft tissue haemorrhage is a rare but potentially life-threatening condition, affecting
anticoagulated patients. Endovascular embolization has emerged as the preferred treatment when
conservative management fails.
This retrospective observational study analysed 60 anticoagulated patients treated with transarterial
embolization between January 2022 and December 2023. Patients were stratified based on embolic
agents used: coils-only versus coils combined with polyvinyl alcohol (PVA) particles. Demographics,
clinical presentation, procedural details, and outcomes were collected. Technical and clinical success,
post-procedural haemoglobin concentration levels, reintervention rates, and 15-day mortality were
assessed.
Results or Findings: Technical success was achieved in all cases with no major complications. No statistically significant
differences were found between coils and coils plus PVA groups in terms of haemoglobin
concentration variation, transfusion or reintervention need, nor mortality. Mortality at 15 days was
28,6%. Lower systolic and diastolic blood pressures, as well as higher international normalized ratio
and prothrombin time, were associated with increased mortality. Higher diastolic blood pressure
emerged as a strong predictor of survival.
Although literature suggests possible benefits of combining coils with PVA, our findings did not
demonstrate superior outcomes for the combination therapy. Nonetheless, the study supports the
safety and efficacy of transarterial embolization in this clinical setting.
Conclusion: Early intervention and haemodynamic stability appear more critical for survival than the choice
between coils versus coils plus PVA particles.
Limitations: The main limitation is the retrospective observational nature of the study.
Funding for this study: This study did not receive any funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was submitted and approved by the ethics committee of the institution where it was carried out.

Author Block: E. Battiato, F. Tiralongo, M. D'Urso, G. Vitaliti, D. G. Castiglione, D. Falsaperla, F. Libra, F. Vacirca, A. Basile; Catania/IT
Purpose: To provide a systematic review on prophylactic transarterial embolization (pTAE) after endoscopic hemostasis in high‑risk non‑variceal upper gastrointestinal bleeding (NVUGIB), focusing on selection criteria, technical conduct by arterial territory and embolic material, clinical outcomes, complications.
Methods or Background: Systematic PubMed and Scopus search (Jan 2010–Sep 2025) included original pTAE studies after successful endoscopic hemostasis and excluded case reports, abstracts, studies focused on variceal bleeding, empiric embolization for angiography-negative bleeding, and systematic reviews/meta‑analyses. Finally, 10 studies were included in this review: two randomized clinical trials, three prospective studies, five retrospective studies.
Results or Findings: Randomized evaluation did not show an overall reduction in 30‑day rebleeding in intention-to-treat analysis, but suggested benefit in large ulcers (≥15 mm) with lower transfusion needs, and no embolization-related ischemia among treated patients.
Kaminskis et al. reported lower rebleeding and fewer surgery with prophylaxis across matched comparators, also in high‑risk profile (Rockall ≥ 7) without excess mortality or ischemic events.
In a series treating duodenal ulcer bleeding, early rebleeding occurred in 11% of cases. Major complications (4%) including hepatic coil migration, highlighting the need for meticulous technique.
Prophylactic TAE showed numerically less rebleeding and 30‑day mortality than therapeutic TAE, with comparable complications.
Endovascular therapy compared with surgery shows similar mortality rates, higher rebleeding rates, and substantially fewer major complications.
TAE versus surgery after failed endoscopy showed similar 30‑day mortality but fewer complications with TAE, with a pTAE subset present but not separately analyzed, underscoring endovascular safety while recognizing rebleeding as the key trade‑off in this pathway.
Conclusion: pTAE is feasible, generally safe, and appears to reduce rebleeding and surgical rescue in well‑selected patients. Routine application across high‑risk presentations is not supported by randomized evidence or guidelines.
Limitations: N/A
Funding for this study: N/A
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: D. Santangelo, A. Campisi, D. Palumbo, C. Canevari, F. Ratti, F. Cipriani, A. Chiti, M. Catena, F. De Cobelli; Milan/IT
Purpose: To evaluate the safety and efficacy of liver venous deprivation(LVD) in inducing volumetric and functional hypertrophy, and its impact on resectability in patients with perihilar cholangiocarcinoma(pCCA).
Methods or Background: We retrospectively analyzed 25 patients with histologically confirmed pCCA who underwent LVD between May 2020 and May 2025. LVD was indicated when volumetric future liver remnant (FLR) was <35% or functional FLR was <2.69%/min/m² on 99mTc-mebrofenin hepatobiliary scintigraphy. FLR volumetry was measured at baseline (pre-LVD), 5–15 days post-LVD (time point 1), and 15–30 days post-LVD (time point 2). FLR function was assessed with 99mTc-mebrofenin scintigraphy at baseline and within 30 days after LVD. Primary endpoints were technical success, safety, and post-LVD resection rate. Secondary endpoints included volumetric and functional hypertrophy metrics (degree of hypertrophy (DH) and kinetic growth rate (KGR)) and surgical outcomes, including post-hepatectomy liver failure (PHLF) per ISGLS criteria.
Results or Findings: Baseline median volumetric FLR was 30.0%, and functional FLR was 1.81%/min/m². Biliary drainage was present in 21/25 (84%); median bilirubin was 3.5 mg/dL. Technical success was 100%; one patient (4%) developed a subcapsular hematoma, managed conservatively. At time point 1, median volumetric FLR was 37% (DH 12.7%; KGR 8.1%/week). At time point 2, median volumetric FLR was 41% (DH 16%; KGR 5%/week). In 15 patients with scintigraphy, median post-LVD functional FLR increased to 3.08%/min/m². Surgical resection was performed in 19/25 (76%) at median 40 days post-LVD. Major complications (Clavien–Dindo ≥III) in 14/19 (73.7%). Grade C PHLF in 3/19 (15.8%); 90-day mortality was 15.7%.
Conclusion: LVD was feasible and safe in pCCA, produced substantial volumetric and functional hypertrophy of the FLR, and increased resectability in this cohort. High postoperative morbidity underscores the importance of careful patient selection and perioperative optimization strategies.
Limitations: retrospective. Small sample size.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Leatum 64/INT/2021