Predictions made on the future of embolization at GEST 2023

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Speaking in the Vanguard session on the first day of the 2023 Global Embolization Oncology Symposium (GEST, 18­–21 May, New York City, USA) yesterday, Lindsay Machan (University of British Columbia, Vancouver, Canada) gave a comprehensive outlook on the next five years in embolization, outlining procedures that will be characteristic, and the advancements that are needed to propel practice into the future.

Machan began by describing the first therapeutic embolization in 1972, defining the achievement via the radiologists’ “conviction”, the equipment of the time, the research that was carried out and the comparisons drawn with existing treatment options which enacted its success.

Skipping ahead to present day, Machan introduced the current and future expansion of therapeutic embolization, briefly listing the areas he predicts to be of note including musculoskeletal (MSK) embolization, granulomatous amoebic encephalitis (GAE), shoulder/elbow enthesopathy/tendinopathy, osteoarthritis (OA) hand, lumbar facet disease and acute sporting injuries.

Observing the applications of MSK embolization, Machan stated that complex knee pain, PCS and neural mechanisms are key areas which would benefit most from the advancement of MSK embolization. Interrogating what is needed to advance the field, Machan emphasised that improved data sought through large, prospective, multicentre trials, as well as smaller and resorbable embolics are the pathways to take to do so.

Next, addressing lymphatic interventions such as peripheral lymphatic embolization, retrograde transvenous and transcervical accesses and mesenteric lymphangiography, Machan moved on to explore future opportunities within embolization. Referencing a study published in Radiology titled ‘Imaging and interventions for lymphatic and lymphatic-related disorders’, Machan explained that the lymphatic system is involved in all disorders that present with fluid accumulation. For this reason, he opined that more evolved imaging, better access tools and new embolic agents are essential to continued progression in the specialty.

Acknowledging two pivotal changes, the speaker then recognised the seismic shifts artificial intelligence (AI) and consumerism have made in healthcare delivery. Discussing the role of AI in embolization, Machan noted a preliminary study—published in the Annals of Vascular Surgery—that concerned AI-assisted microcatheter shaping for intracranial aneurysm coiling by Changya Liu (Huazhong University of Science and Technology, Wuhan, China). Using this example, the speaker then used the increasing prevalence of AI’s deployment within treatment to draw attention to the growing imbalance between healthcare—which makes up a sixth of US gross domestic product (GDP)—and the economy, which is expanding at a much slower rate. Additionally, he stated that medical errors are the eighth leading cause of death in the USA, while too making note of the “easily tracked” cost versus outcome dichotomy in contemporary treatment.

Concluding his presentation, Machan painted a clear picture of the future of embolization, making particular mention of more frequent MSK embolization and lymphatic procedures to come, alongside reduced usage of onxy and glue. He averred that healthcare professionals in this space will “continue to be referred patients that no one else wants to treat”, however he affirmed that it is essential that time is used advantageously to create data and exploit the pervading “digitisation of everything”.


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