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

Purpose: Percutaneous transluminal angioplasty for forearm arteriovenous fistula stenosis is frequently associated with significant pain, which may hinder patient cooperation. Ultrasound-guided cutaneous nerve blocks were evaluated as an alternative analgesic method for percutaneous transluminal angioplasty in forearm arteriovenous fistula, with the aim of reducing pain without motor paralysis or systemic complications.

Material and methods: This retrospective, single-center study included 77 patients who underwent percutaneous transluminal angioplasty for forearm arteriovenous fistula stenosis with ultrasound-guided cutaneous nerve block using lidocaine in October 2024. Target nerves included the lateral antebrachial cutaneous nerves, the superficial branch of the radial nerve, and/or the medial antebrachial cutaneous nerves. We retrospectively collected data on block time, percutaneous transluminal angioplasty duration, lidocaine volume, complications, presence or absence of postanesthetic motor paralysis, and analgesic efficacy. Analgesic efficacy was graded as excellent, good, or poor, with "poor" defined as pain necessitating supplemental local infiltration anesthesia for adequate relief.

Results: The mean block preparation time was 2.1 ± 0.5 min, and the percutaneous transluminal angioplasty duration was 27.3 ± 9.2 min. The mean volume of 1% lidocaine used was 2.6 ± 1.1 mL. Minor hematomas were observed in eight cases. No patient experienced postanesthetic motor paralysis. Analgesia was rated excellent in 57.1% of patients and good in 29.9%, while poor analgesia occurred in only 12.9%. A superficial branch of the radial nerve block improved outcomes in distal forearm lesions.

Conclusions: Ultrasound-guided cutaneous nerve blocks provide rapid, effective, and motor-sparing analgesia for percutaneous transluminal angioplasty of forearm arteriovenous fistula stenosis, making them suitable for outpatient use and warranting further prospective evaluation.

Purpose: To retrospectively evaluate the safety and efficacy of direct oral anticoagulant therapy for fibrin sheath-induced central venous port system dysfunction.

Material and methods: Between May 2023 and February 2024, patients who underwent direct oral anticoagulant therapy for fibrin sheath-induced central venous port system dysfunction were included. The clinical effectiveness, flow confirmation study, central venous port function, and adverse events according to the Common Terminology Criteria for Adverse Events classification were retrospectively reviewed.

Results: Nine patients were included in the study. The catheter types were open-ended (n = 8) and Groshong (n = 1). All patients had difficulty with aspiration, and one exhibited injection resistance. All patients received edoxaban as direct oral anticoagulant, at doses of 30 mg (n = 3) or 60 mg (n = 6) based on their body weights. After direct oral anticoagulant administration, complete fibrin sheath resolution was confirmed by a flow confirmation study in all cases, with a mean duration of 29 ± 21 days. Concurrently, the central venous port system dysfunction was restored in eight cases. In the remaining one case, direct oral anticoagulant administration was suspended on day 26 due to grade 1 epistaxis; therefore, central venous port system dysfunction remained despite the disappearance of the fibrin sheath. Thus, the clinical success rate was 88.9% (8/9) and fibrin sheath disappearance rate was 100% (9/9), respectively. No grade 3 or higher adverse effect was observed. No recurrence of fibrin sheath-induced central venous port system dysfunction was observed during the mean follow-up period of 133 ± 98 days.

Conclusions: Direct oral anticoagulant administration can be a potentially effective and safe strategy for managing fibrin sheath-induced central venous port system dysfunction formation.

A man in his 60s presented with severe epigastric pain. Abdominal computed tomography revealed an aneurysm of the right gastric artery, which branched from an aberrant gastroduodenal artery originating from the axis of the splenic artery. Other vascular anomalies included a left gastric artery arising directly from the aorta and several additional arterial variations. Computed tomography also revealed stenosis of the axes of the celiac artery and left gastric artery. The aneurysm was thought to be caused by the stenosis due to median arcuate ligament syndrome. Transcatheter arterial embolization was successfully performed. This case highlights that median arcuate ligament syndrome combined with vascular anomalies can alter hemodynamics and lead to the development of uncommon gastric artery aneurysms.

Purpose: To evaluate the efficacy of needle tract sealing using normal saline instillation for decreasing the risk of pneumothorax after computed tomography-guided lung biopsy.

Material and methods: This retrospective, single-institution study included 391 computed tomography-guided lung biopsies performed by 12 operators between January 2022 and October 2024. After exclusion, 298 biopsies were analyzed by comparing the saline seal (n = 138) and control (n = 160) groups. A 17/18-gauge or 19/20-gauge coaxial biopsy system was used, and tract sealing was performed by instilling 1-5 mL of normal saline during the withdrawal of the introducer needle in the saline seal group; tract sealing was not performed in the control group. After 1:1 propensity score matching was performed to balance baseline characteristics, the incidences of pneumothorax and chest tube placement were compared between the two groups using Fisher's exact test.

Results: After propensity score matching, 108 pairs (mean lesion size: 17 mm) were well balanced. The incidence of pneumothorax did not differ significantly between the control and saline seal groups (50.0% vs. 60.2%, respectively; p = 0.171). Similarly, the incidence of chest tube placement was not significantly different between the two groups (7.4% vs. 13.0%, respectively; p = 0.260).

Conclusions: According to the propensity score-matched analysis, normal saline instillation for tract sealing did not significantly reduce the incidence of pneumothorax or chest tube placement. In our cohort, which had a high prevalence of small lesions, saline sealing alone may be insufficient to reduce post-biopsy pneumothorax risk. Hence, combined strategies require further investigation.

Portal vein stenting treats stenosis or thrombosis of the portal venous system with relatively high technical and clinical success rates. However, complications have been reported. We present a case of a 58-year-old woman with a history of pancreatic head cancer surgery who developed superior mesenteric vein occlusion owing to recurrent mesenteric lesions. Portal vein stenting was performed; however, it resulted in superior mesenteric artery occlusion, which caused extensive intestinal ischemia. Gas from the intestinal necrosis migrated into the superior mesenteric artery and superior mesenteric vein, and thrombotic occlusion of the portal vein stent was observed. This complication, which is characterized by superior mesenteric artery occlusion induced by portal vein stenting, is unique. Furthermore, this case highlights the need for a thorough preoperative evaluation and careful consideration to avoid such a rare but severe complication.

Gastric variceal rupture requires rapid hemostasis. When an abdominal balloon catheter is unavailable, alternatives are needed. We report emergency plug-assisted retrograde transvenous obliteration performed with a 9-Fr Optimo balloon-guiding catheter in a 59-year-old man with alcoholic cirrhosis and fundal gastric varices. Under balloon occlusion, balloon-occluded retrograde transvenous venography delineated the variceal complex. A 10-mm Amplatzer Vascular Plug II was deployed via the Optimo, followed by stepwise injection of gelatin sponge particles through a high-flow microcatheter. Complete occlusion was achieved without complications. Follow-up computed tomography and endoscopy confirmed improvement. The Optimo enabled single-system balloon-occluded retrograde transvenous venography, plug deployment, and embolic delivery through one venous access, offering a practical option for urgent hemostasis when inventory constraints exist, provided that preprocedural computed tomography confirms device compatibility.

We present a novel salvage technique for managing a completely occluded percutaneous nephrostomy catheter in a patient with metastatic cervical cancer and bilateral obstructive uropathy. While the left nephrostomy catheter was exchanged uneventfully, the right was entirely blocked, preventing standard guidewire passage. Using the Accustick II Introducer System (Boston Scientific, Spencer, IN, USA), a 21-gauge needle was advanced through the cut percutaneous nephrostomy lumen to traverse the obstruction, penetrating the catheter sidewall and access the renal collecting system. This allowed sequential guidewire and sheath introduction, enabling successful percutaneous nephrostomy replacement through the existing tract. Termed the Sharp Urologic Recanalization technique, this method modernizes traditional sharp recanalization strategies and offers a less invasive alternative when conventional techniques fail.

Median arcuate ligament syndrome is a rare condition that can lead to aneurysm formation in collateral vessels due to celiac artery compression. While pancreaticoduodenal artery aneurysms are common, esophageal artery aneurysms are extremely rare. We report a case of a ruptured proper esophageal artery aneurysm associated with median arcuate ligament syndrome in a 61-year-old woman. Emergency transarterial embolization using N-butyl 2-cyanoacrylate was performed successfully via the afferent artery. Follow-up imaging confirmed effective embolization with preserved esophageal perfusion and no signs of ischemia. This case highlights the importance of recognizing rare aneurysm sites in median arcuate ligament syndrome, and supports N-butyl 2-cyanoacrylate embolization as a safe and effective treatment for esophageal artery aneurysms.

An 83-year-old man presented with chronic right shoulder pain and stiffness from recurrent subacromial-subdeltoid bursitis associated with rotator cuff tears, despite initial conservative measures. He refused surgery but agreed to transarterial embolization. The first transarterial embolization was performed with 1:1 lipiodol:iohexol emulsion, but provided no significant symptom relief. A repeat transarterial embolization demonstrated recanalization in several branches and new neovascularity. These were successfully embolized with 100 μm embozene particles. Post-procedure, his pain score on the numerical rating scale improved from 6 to 2 at rest and 7 to 3 during motion, no longer requiring regular analgesics. Follow-up ultrasound showed sustained resolution of bursal effusion up to 18 months. This case suggests the efficacy of transarterial embolization in treating recurrent subacromial-subdeltoid bursitis.

Purpose: To evaluate the feasibility of a bilateral flank subcutaneous rat tumor model perfused by the iliolumbar artery, as a reproducible platform for preclinical transarterial therapy research. Material and Methods: Eighteen male Lewis rats (median body weight: 295 g; interquartile range: 289-301 g) received bilateral flank implantation of tumor fragments from a pancreatic ductal adenocarcinoma (DSL-6A/C1) that had developed subcutaneously in a donor rat. Upon reaching ≥8 mm in diameter, rats underwent angiography via tail artery access. A microcatheter was advanced into the iliolumbar artery through the aorta, and digital subtraction angiography was used to assess tumor staining. In two animals, either isosulfan blue or fluorescent-labeled nanoparticles were selectively injected via the iliolumbar artery to corroborate radiographic assessment of tumor perfusion. The animal that received fluorescent-labeled nanoparticles was euthanized 24 hours after injection for near-infrared imaging. The remaining rats underwent embolization and were monitored for 72 hours to assess safety. Results: The tumor engraftment rate was 97.2% (35/36). Selective iliolumbar artery catheterization was successful in all rats (100%), with a median procedure time of 20 minutes (interquartile range: 15-25). Digital subtraction angiography confirmed tumor staining in all of the evaluable tumors. Isosulfan blue injection via the iliolumbar artery resulted in whole-tumor staining. Fluorescence imaging revealed higher fluorescent signal intensity in the treated tumor compared with the contralateral side. No major complications, including skin ischemia, claudication, or paralysis were observed. Conclusions: This minimally-invasive model allows for highly reproducible subcutaneous tumor engraftment and reliable selective iliolumbar artery catheterization, providing a straightforward, technically feasible, and practical platform for transarterial therapy studies in rats.