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This CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for performing liver regeneration therapies prior to major hepatectomies, including portal vein embolization, double vein embolization and liver venous deprivation. It has been developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. It encompasses all clinical and technical details required to perform liver regeneration therapies, revising the indications, contra-indications, outcome measures assessed, technique and expected outcomes.

A 66-years old male patient presents with lower urinary tract symptoms, mostly due to obstructive symptoms, and an enlarged prostate with 80 cm3, with a broad-based median lobe, suggestive of benign prostatic obstruction (BPO). Trans-urethral resection of the prostate (TURP) was proposed. However, the patient desired to preserve ejaculatory function and was afraid of a potential negative impact on erectile function. Thus, the patient inquired about minimally invasive therapies (MITs) as alternatives to TURP. In this review, currently available MITs for BPO are described including prostatic artery embolization, water vapor thermal therapy (Rezum®), prostatic urethral lift, iTIND® (temporary implantable device) and aquablation (Aquabeam®). Focus is given on the description of the technique, level of evidence and advantages over conventional surgical options.

Objectives: To develop and internally validate a pre-treatment score for the safe selection of the best candidates for the transradial approach when performing liver cancer intra-arterial procedures. Methods: One hundred and twenty-two patients undergoing hepatic endovascular treatments via radial access between January and December 2022 were retrospectively selected to develop a prediction model. Pre-procedural imaging data were analyzed, and variables were selected to develop the RAD-access score. Intra-procedural data were analyzed to assess effective procedural complexity (ePC). The relationship between ePC and pre-procedural variables was statistically tested, and cutoff points were defined. Results: A final score (RAD-access) was created and prospectively validated on 139 patients enrolled between June and September 2023. Aortic arch diameter and angulation, left subclavian artery angulation, suprarenal abdominal aorta diameter, celiac trunk take-off angle, and radial artery diameter were the significant variables used to build the score. In the validation cohort, based on the pre-treatment RAD-access score, 69 patients underwent a transradial approach, with a significantly lower ePC rate obtained (78.2% easy, 20.3% intermediate, 1.5% complex). No major adverse events occurred. Conclusions: Pre-treatment RAD-access score provides a good prediction for the procedural complexity of the transradial approach in patients undergoing liver cancer intra-arterial treatments, identifying the best candidates for an easy and safe transradial procedure.

This CIRSE Standards of Practice document is developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. It aims to assist Interventional Radiologists in their daily practice by providing best practices for conducting meetings on morbidity and mortality.