Interventional radiology (Higashimatsuyama-shi (Japan)最新文献

Ultrasound-guided needle puncture is essential for both vascular and nonvascular interventions. Ultrasound is widely available in various clinical settings, requires no ionizing radiation, offers color Doppler imaging, and enables real-time visualization of the needle position during puncture. However, ultrasound imaging has some limitations, such as signal attenuation in deeper tissues and the inability to penetrate bone or air, and it is a heavily operator-dependent modality. Here, we outline the basic techniques and technical tips for ultrasound-guided needle puncture.

This article emphasizes image-guided puncture, a common technique used by interventional radiologists. It focuses on ultrasound, fluoroscopy, computed tomography, and computed tomography fluoroscopy-guided procedures. While techniques vary, successful outcomes without complications still heavily rely on operators' skill and judgment. Operators need knowledge of needle characteristics and expert needle manipulation. Continual skill refinement through daily practice is essential, aiming maximum results with minimal invasiveness. This article examines challenging cases of percutaneous needle biopsy, biliary intervention, radiofrequency ablation, and percutaneous abscess drainage while referencing previous review articles and discusses how to succeed in these cases by employing various techniques and approaches in various image-guided procedures. This article aimed to provide interventional radiologists with a comprehensive and practical guide for enhancing their image-guided puncture techniques, ultimately leading to successful outcomes.

Many pathological conditions involve the head and neck organs, which have complicated anatomy and functions. Recent advances in endovascular treatment have enabled clinicians to use it for treating various lesions, including hemorrhagic conditions, hypervascular tumors, and vascular malformations. Head and neck lesions may present with region-specific clinical manifestations, angioarchitecture, and complications, particularly regarding cosmetic, ingestion, respiratory, and neuronal functions. Therefore, the treatment strategy should consider cosmetic concerns and the preservation of critical functions. A detailed understanding of functional vascular anatomy and treatment techniques can help achieve successful management of head and neck lesions. This review summarizes the clinical manifestations of head and neck lesions, treatment strategies, and complications.

Purpose: This study aimed to evaluate the clinical outcomes of placing Viabahn stent grafts in visceral arterial injuries and identify the risk factors associated with stent graft occlusion.

Material and method: This multicenter, retrospective study included 29 procedures performed on 26 patients who underwent Viabahn stent graft placement between December 2017 and November 2022. We evaluated technical and clinical success rates, periprocedural complications, and stent graft patency using contrast-enhanced computed tomography. We conducted univariate analysis to examine the risk factors associated with Viabahn stent graft occlusion.

Result: The technical success rate was 96.6% (28 of 29), and the clinical success rate was 86.2% (25 of 29). The periprocedural complication rate was 17.2% (5 of 29), consisting of 4 mild adverse events and 1 patient death. The stent graft patency rates at 1, 3, 6, 12, and 24 months were 85%, 84.2%, 77.8%, 66.7%, and 50%, respectively. Univariate analysis indicated significant correlations between the lack of antiplatelet medication (P = .00074) and SG oversize ≥ 20% (P = .047).

Conclusions: This trial demonstrated the safety and effectiveness of Viabahn stent graft placement for visceral arterial injuries with high patency rates. Additionally, this study identified the lack of antiplatelet treatment and Viabahn oversize ≥ 20% as significant risk factors for Viabahn stent graft blockage in visceral arterial injuries.

We describe a patient who underwent plug-assisted retrograde transvenous obliteration for gastric varices. After the procedure, the patient developed hypotension and tachycardia. Contrast-enhanced computed tomography showed a left adrenal hematoma. The patient was managed with left inferior adrenal artery embolization. We herein describe an unexpected complication during plug-assisted retrograde transvenous obliteration and the endovascular management by adrenal artery embolization. We speculate that inadvertent cannulation of an adrenal vein tributary and iatrogenic trauma thereafter caused by sheath advancement was a probable cause for this complication. Further increase in intra-adrenal pressure due to blockage of the adrenal vein outflow postplug deployment possibly led to the rupture of adrenal vein tributary and adrenal gland hematoma in our case.

Purpose: Distal transradial access through the anatomical snuffbox has been highlighted in recent research because it provides extremely low invasiveness. It has demonstrated its feasibility and safety for cardiac intervention. However, its characteristics for noncardiac intervention are not well known. This report aims to demonstrate the feasibility and safety of noncardiac intervention with distal transradial access, with identification of practical devices for procedures.

Material and method: This retrospective study was conducted from May 2021 to December 2021 with consecutive patients who underwent distal transradial access for noncardiac intervention. This study analyzed patient physical information, procedural details, technical success rates, and distal transradial access-associated complications.

Result: Nine patients (7 females, 2 males) aged 48-69 years (median: 57) were enrolled in this study. This study assessed 11 noncardiac procedures, such as transarterial infusion chemotherapy for head and neck malignancies (n = 4), embolization of visceral artery aneurysm (n = 2), embolization of renal angiomyolipoma (n = 2), percutaneous transluminal renal angioplasty (n = 1), bronchial artery embolization (n = 1), and diagnostic angiography (n = 1). The introducer sheath size was 4-6 French. Catheters respectively having nine tip shapes were used. Reverse curve catheters were used only in two cervical procedures. The technical success rate was 91% (10/11). Of the 11 procedures, only 1 (bronchial artery embolization) required conversion to transfemoral access. There was no complication associated with distal transradial access. Ultrasound evaluation after treatments revealed patent radial arteries in all patients.

Conclusions: Results revealed that distal transradial access is feasible with commercially available catheters and is safe for various noncardiac interventions.

Purpose: A membranous structure (MS) may be seen on ultrasound at a site of vascular access (VA) stenosis in patients on hemodialysis. It can also be encountered during percutaneous transluminal angioplasty (PTA) and be impassable from one side but easily passed from the other. This study aimed to examine the characteristics of MS cases and how to treat them.

Material and method: Percutaneous transluminal angioplasty performed at our hospital for arteriovenous fistula-vascular access stenosis between July 2021 and June 2022 were identified. They were divided into two groups: membranous structure and nonmembranous structure. Data of patients such as age, history of dialysis and vascular access use, number of percutaneous transluminal angioplastys performed for vascular access, and diabetes status were collected. Membranous structure cases were examined in terms of puncture direction.

Result: A total of 72 percutaneous transluminal angioplasty were performed in 37 patients. Membranous structure was identified in nine percutaneous transluminal angioplastys. Patients with membranous structure were older than those without membranous structure (mean age 75.3 ± 7.54 vs. 70.0 ± 10.8 years, P = 0.21) and tended to have a history of vascular access use (57.6 ± 106 vs. 48.4 ± 59.8 months, P = 0.28), a history of dialysis (152 ± 95.6 vs. 91.2 ± 116 months, P = 0.02), fewer percutaneous transluminal angioplasty procedures (1.44 ± 0.726 vs. 3.24 ± 2.69, P = 0.02), and lower incidence of diabetes (1 vs. 38 cases). In the nonmembranous structure group, all percutaneous transluminal angioplastys performed were successful. In the membranous structure group, six percutaneous transluminal angioplastys were successful, two were impassable, and one was acutely occluded. The successful cases and the acute obstruction case were passed by centrally directed puncture. Impassable cases involved peripheral directional puncture.

Conclusions: Vascular access stenosis can be caused by membranous structure and successfully treated by bidirectional puncture.

Purpose: During thoracic endovascular aortic repair for complicated Stanford type B aortic dissection, large bare stent placement for the abdominal aorta is sometimes necessary. In smaller abdominal aortic diameter cases, we used the stripped AFX aortic cuff as a scaffolding bare stent rather than the Zenith Dissection Endovascular Stent, which is a commercially available, large bare stent. In this study, we evaluated the feasibility of the stripped AFX aortic cuff and experiments were conducted to compare the stripped AFX and the Zenith Dissection Endovascular Stent.

Material and method: The type B aortic dissection patients treated with thoracic endovascular aortic repair using stripped AFX at three institutions between January 2014 and December 2017 were retrospectively reviewed. Clinical data, including technical success, perioperative complication, and overall survival, were evaluated. The experiment assessed the chronic outward force that reflected the load acting on the artery wall from the stent.

Result: Eight cases (seven males) were reviewed. The median (interquartile range, IQR) age of the patients was 60 years (46.3-70.3). The technical success rate was 100%, and no perioperative complications were observed. The median (IQR) follow-up period was 28.9 months (17.5-31.5). During the follow-up, one patient died of septic shock unrelated to aortic events. The median (IQR) diameter of the stripped AFX on the last follow-up CT was 23.5 mm (21.9-25.0). The chronic outward force of the Zenith Dissection Endovascular Stent was two to three times that of the stripped AFX.

Conclusions: The stripped AFX aortic cuff is feasible and safe as a scaffolding stent during thoracic endovascular aortic repair for Stanford Type B aortic dissection.

Computed tomography-guided puncture is a useful technique for various interventional radiology procedures. Puncture from various locations and angles becomes possible using this technique. Moreover, bone and air do not interfere with the computed tomography image. Therefore, computed tomography-guided puncture is feasible even in difficult cases of ultrasonography-guided procedures. However, a computed tomography-guided procedure can cause radiation exposure to patient and operator. Therefore, utmost attention should be given to minimizing radiation exposure. This study aimed to provide a brief review of pre-procedural preparation and the technical tips for the computed tomography-guided puncture and introduce recent topics related to the radioprotection of computed tomography-guided puncture.