procedures, including patients with obesity who could not achieve significant weight loss despite behavioral and pharmacologic therapies, patients who were ineligible or elected not to have bariatric surgery, patients with weight regain after bariatric surgery, and patients with obesity and concomitant liver diseases who required endovascular interventions for their hepatic pathology.


With the current FDA regulatory guidelines in mind, the panelists agreed that achieving a 10% weight loss at 12 months was a desirable therapeutic goal for IR bariatric interventions and might facilitate these procedures’ general adaptation by meeting reimbursement criteria. The final consensus on the ideal research design included a blinded randomized controlled trial (RCT) comparing IR obesity procedures versus sham control arms, with all patients receiving behavioral weight loss therapy. The panelists concluded that the RCT study design generated the highest level of evidence for evaluating device or procedural safety, efficacy and justifications for reimbursement.


The results of this panel have been submitted to the Journal of Vascular and Interventional Radiology.


What’s next for BE? Although data indicate that BE is safe for human use, several questions remain unanswered and deserve future investigation.


• First, the long-term vascular outcomes, such as the degree of recanalization or collateralization and gastric perfusion changes, remain unknown. Future research should investigate the long- term effect of revascularization as it


1977


(1977–78) The embolization technique for pulmonary arteriovenous malformations and varicoceles is put forth.


pertains to the procedure’s efficacy and durability to sustain weight loss.


• Second, whether bariatric embolization predisposes patients to an increased risk of future bariatric surgery remains to be determined.


• Third, future studies should explore the technical feasibility of performing bariatric embolization in patients after bariatric reconstructive surgeries (i.e., Rou-en-Y gastric bypass), as these patients represent a potentially untapped population that may benefit from a less invasive procedure.


• Finally, in patients with local revascularization after bariatric embolization, the feasibility and safety of repeat LGA embolization and its long-term weight loss efficacy should be investigated.


References


1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Products—Data Briefs—Number 360—February 2020. 2020; Available at: cdc.gov/nchs/ products/databriefs/db360.htm.


2. Childhood Obesity Facts | Overweight & Obesity | CDC. 2021; Available at: cdc.gov/obesity/data/ childhood.html.


3. Singh GM, Danaei G, Farzadfar F, et al. The age- specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: A pooled analysis. PLoS One. 2013;8:e65174.


4. Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD. Body mass index, waist circumference and waist–hip ratio: Which is the better discriminator of cardiovascular disease mortality risk? Evidence from an individual-participant meta-analysis of 82,864 participants from nine cohort studies. Obes Rev 2011;12:680–687.


5. Anandacoomarasamy A, Caterson I, Sambrook P, Fransen M, March L. The impact of obesity on the musculoskeletal system. Int J Obes (Lond) 2008;32:211–222.


6. Mitchell AB, Cole JW, McArdle PF, et al. Obesity increases risk of ischemic stroke in young adults. Stroke 2015;46:1690–1692.


in 10 YEARS


WHAT COMES NEXT?


We need to be looking to further partner with our biotech and


biomedical colleagues. Wearable technologies are becoming available to alert patients about their heart failure, blood sugar levels and heart rhythm. If we had devices that could detect a blood clot in a leg, around a central venous line or in the lung, or reveal decreasing flow rates in a dialysis fistula before it clots or show cancer progression, we could potentially identify problems earlier in a disease process and intervene as needed to keep patients out of the hospital, improve outcomes and potentially lower the over-all cost of care. Some of these technologies would empower IRs to be more important in future care models, but it will require IRs to become more involved with these innovations.


— ALAN H. MATSUMOTO, MD, FSIR


1978


(1977–83) Bland- and chemoembolization for treatment of hepatocellular cancer and disseminated liver metastases is created.


1979


1980


Three unique techniques are put forth:


• Cryoablation of liver tumors


• Development of special tools and devices for biliary manipulation


• Biliary stents to allow bile to flow from the liver saving patients from biliary bypass surgery.


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