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

Percutaneous interventions are widely performed for bile duct injuries due to surgery, trauma, and local ablation or transarterial chemoembolization for hepatocellular carcinoma. Most bilomas can be treated with percutaneous drainage alone, but additional biliary drainage or plastic stenting in the common bile duct, dilation of the coexisting biliary stricture, or embosclerosis is also required for refractory bilomas. For bile duct occlusions or disruptions, percutaneous transhepatic biliary drainage and long-term catheter placement across the affected segment are recommended. In addition, intrahepatic biliary ablation and/or percutaneous transhepatic portal vein embolization is effective for refractory bile leaks. Percutaneous drainage is required for infected necrotized hepatocellular carcinoma due to ascending cholangitis after transarterial chemoembolization. Plastic stent placement is also recommended for main bile duct strictures caused by transarterial chemoembolization.

We report a case of a large pheochromocytoma in a middle-aged woman with a good past health record. She presented with pheochromocytoma crisis, complaining of acute shortness of breath, and quickly deteriorated into refractory cardiogenic shock with multiorgan failure. Multi-axial CT showed a large mass in the left suprarenal region. Elevated serum catecholamines confirmed the diagnosis of pheochromocytoma. Left distal transradial adrenal artery embolization under local anesthesia was performed because of limited femoral access and very high perioperative risk. The aim was to devascularize the tumor and reduce catecholamine secretion. Her labile blood pressure improved after embolization. She gradually recovered and underwent adrenalectomy three weeks later.

Purpose: To determine the optimal virtual-target definition for detecting renal cell carcinoma feeders using transarterial computed tomography angiography with automated feeder-detection software. Material and Methods: This retrospective study included 17 patients with 17 renal cell carcinomas who underwent transarterial ethiodized-oil marking before cryoablation. Tumor feeders were automatically detected on transarterial renal computed tomography angiography images using the automated feeder-detection software with three virtual-target definitions: small (ellipsoidal area maximized within the tumor contour), medium (ellipsoidal area covering the entire tumor with a minimal peripheral margin), and large (ellipsoidal area including the tumor and a 5-mm peripheral margin). The detected feeders were classified as true or false positives according to the findings of selective renal arteriography, by consensus of two interventional radiologists. Feeder-detection sensitivity and the mean number of false-positive feeders per tumor were calculated for each virtual-target definition. Results: For 17 tumors, 25 feeding arteries were identified on the arteriography. The feeder-detection sensitivity of the software was 80.0% (20/25), 88.0% (22/25), and 48.0% (12/25) for small, medium, and large virtual targets, respectively. The mean ± standard deviation number of false-positive feeders per tumor was 0.82 ± 1.3, 1.41 ± 1.1, and 2.82 ± 1.6 when using small, medium, and large virtual-target definitions, respectively. Conclusions: The detection rate of renal cell carcinoma feeders with the automated feeder-detection software varies according to the virtual-target definition. Using a medium virtual target, covering the entire tumor with a minimal peripheral margin, may provide the highest sensitivity and an acceptable number of false-positive feeders.

Purpose: To investigate the optimal order of mixing N-butyl-2-cyanoacrylate-Lipiodol-iodine contrast materials (N-butyl cyanoacrylate-Lipiodol-iodinated contrast material). Materials and Methods: Lipiodol was used as an oil-based contrast material. Three types of water-soluble iodinated contrast materials were used: iopamidol, iohexol, and iomeprol. The materials were mixed in three different orders: N-butyl cyanoacrylate-Lipiodol-iodinated contrast material, in which N-butyl-2-cyanoacrylate was first mixed with Lipiodol and then with iodinated contrast materials; N-butyl cyanoacrylate mixed first with an iodinated contrast material and then with Lipiodol, in which N-butyl-2-cyanoacrylate was first mixed with iodinated contrast material and then with Lipiodol; and Lipiodol mixed first with an iodinated contrast material and then with N-butyl cyanoacrylate, in which Lipiodol was first mixed with iodinated contrast materials and then with N-butyl-2-cyanoacrylate. N-butyl cyanoacrylate-Lipiodol-iodinated contrast material was prepared at two ratios: 2:3:1 (N-butyl cyanoacrylate-Lipiodol-iodinated contrast material 231) and 1:4:1 (N-butyl cyanoacrylate-Lipiodol-iodinated contrast material 141). The particle sizes and injection pressures of the mixtures were measured, and their adhesiveness was evaluated. Results: N-butyl cyanoacrylate mixed first with Lipiodol and then with an iodinated contrast material and Lipiodol mixed first with an iodinated contrast material and then with NBCA could be prepared, but N-butyl cyanoacrylate mixed first with Lipiodol and then with an iodinated contrast material could not because of immediate polymerization between N-butyl-2-cyanoacrylate and iodinated contrast material. N-butyl cyanoacrylate mixed first with Lipiodol and then with an iodinated contrast material mixtures had large, irregular particles (33.1-126.5 μm) with non-uniform distribution. Lipiodol mixed first with an iodinated contrast material and then with N-butyl cyanoacrylate mixtures yielded significantly smaller, uniformly distributed particles (1.6-3.3 μm) irrespective of contrast material type. Both Lipiodol mixed first with an iodinated contrast material and then with NBCA and NBCA mixed first with Lipiodol and then with an iodinated contrast material mixtures showed no catheter adhesiveness. Conclusions: Lipiodol mixed first with an iodinated contrast material and then with NBCA is an appropriate mixing order because of its uniform particle sizes irrespective of contrast materials, and low adhesiveness compared with other mixtures.

Lymphatic ascites developed in a woman in her fifties after she underwent total hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection for endometrial carcinoma. Approximately 500-1,000 mL of opalescent fluid was drained daily. Initially, dietary fat restrictions failed to reduce ascites. Two lipiodol lymphangiographies identified leaks from the iliac lymphatic vessels but were only partially successful at occluding these leaks. Octreotide injection and clamping of the drainage tube were attempted without success. On postoperative day 68, a mixture of lipiodol and n-butyl-2-cyanoacrylate was injected to embolize the leakage point, significantly reducing symptoms. The patient was discharged on day 76, and follow-up computed tomography two months later showed complete resolution of ascites. One year after surgery, the patient remained symptom-free.

Purpose: Transarterial chemoembolization for hepatocellular carcinoma can be combined with radiofrequency ablation to improve local control. Radiofrequency ablation is usually performed under ultrasound guidance. Computed tomography can detect lesions in the whole liver, but when performing liver puncture under conventional computed tomography guidance, peripheral intrahepatic vessels cannot be visualized, risking vascular injury. The efficacy and safety of radiofrequency ablation under computed tomography guidance combined with transarterial chemoembolization were evaluated. Material and Methods: A total of 186 procedures performed in 142 patients with hepatocellular carcinoma between September 2016 and December 2021, in which radiofrequency ablation was performed under computed tomography guidance combined with transarterial chemoembolization were evaluated. Patient background, survival, local recurrence, adverse events, and post-procedural bleeding were evaluated. Results: Overall, 28 women and 114 men (median age, 74 years; age range, 49-90 years) were evaluated. The etiology of hepatocellular carcinoma was hepatitis B, hepatitis C, hepatitis B+C, and hepatitis non-B non-C in 49, 27, 28, and 38 patients, respectively. The Child-Pugh score was 5/6/≥7 in 137/41/8, and modified albumin-bilirubin was 1/2a/2b/3 in 97/45/42/2, respectively. The 1-, 2-, and 3-year overall survival rates were 96.1%, 87.4%, and 74.0%, respectively. Local recurrence developed after 33/186 procedures, and the 1-, 2-, and 3-year local recurrence-free survival rates (per procedure) were 86.4%, 76.6%, and 57.5%, respectively. Post-procedural bleeding occurred in 17/186 procedures; 13 required embolization, and 4 stopped bleeding spontaneously. Conclusions: Computed tomography-guided radiofrequency ablation with simultaneous transarterial chemoembolization is a useful treatment for early-stage hepatocellular carcinomas that cannot be detected on ultrasound.

Purpose: This retrospective study investigated the factors influencing the difficulty and complications of peripherally inserted central catheter insertion. Material and Methods: The study evaluated 189 cases of peripherally inserted central catheter insertion (139 patients) performed in our angiography unit from October 2023 to March 2024. Each vein was punctured under ultrasound guidance, and a guidewire and catheter were advanced under fluoroscopic guidance. The patients were classified into two groups based on the procedural time (≤10 minutes [short group] and >10 minutes [long group]), number of punctures, occurrence of procedure-related complications, and performance of venography, and patient characteristics and procedural details were compared in these groups. Results: The long group featured a significantly higher proportion of female patients, deeper vessel depth, smaller vessel diameter, and higher proportion of junior residents among the operators than in the short group. The multiple-puncture group had a significantly younger age, higher proportion of female patients, and deeper vessel depth than the single-puncture group. The complication group had a younger age, lower platelet count, and deeper vessels than the non-complication group. The venography group exhibited a significantly smaller vessel diameter than the non-venography group. Conclusions: For peripherally inserted central catheter insertion, younger age, female sex, deeper and smaller vessels, and less operator experience were associated with procedural difficulty. Younger age, low platelet counts, and deeper vessels were associated with procedural complications. A smaller vessel diameter was associated with the need for venography. These factors should be considered when selecting the operator, insertion site, method, and operation site to ensure a reliable procedure.

Purpose: To review the utility of a spring-loaded blunt-tip co-axial needle in improving procedural outcomes when accessing "difficult-to-reach" targets during percutaneous image-guided procedures. Material and Methods: In this single-center retrospective study, consecutive adult patients who underwent percutaneous image-guided procedures using a spring-loaded blunt-tip co-axial needle for "difficult-to-reach" targets from January 2021 to December 2024 were reviewed. Clinical information, including demographics and medical history, was recorded. Pre- and post-procedural radiological findings were assessed. Procedural details, modality of image guidance, technical success, and complications were analyzed. Post-procedural follow-up was reviewed. Results: A total of 21 patients (median age: 68.0 years, range 33.0-88.0 years; 15 [71.4%] male) were included. Nearly half (n = 10, 47.6%) of the procedures were percutaneous image-guided drainage. One-third (n = 7, 33.3%) were hydrodissection performed for radiofrequency or microwave ablation of tumors. Three (14.3%) were image-guided biopsies. In one patient (4.8%), the needle was used for percutaneous embolization of a type II endoleak after endovascular repair of an enlarging internal iliac artery aneurysm. No procedure-related complication was encountered. In all 21 cases, adjacent organs were avoided, resulting in retained drainage, achieved tumor control with ablation, achieved tissue diagnosis with biopsy, and eliminated endoleak (100% technical success). Conclusions: The spring-loaded blunt-tip co-axial needle appeared to be useful in accessing "difficult-to-reach" targets in a variety of percutaneous image-guided procedures, including drainage, hydrodissection, biopsy, and percutaneous embolization of endoleak.

Purpose: To evaluate the feasibility of aorto-uni-iliac endovascular aortic repair using the Gore Excluder in selected patients. Material and Methods: This retrospective study reviewed five cases of aorto-uni-iliac endovascular aortic repair for abdominal aortic aneurysm using the Gore Excluder between January 2014 and January 2024. Patient demographics, procedural details, and postoperative outcomes were evaluated. Study endpoints included technical success, overall survival, aneurysm sac changes, endoleak occurrence, secondary interventions, and aneurysm-related death to evaluate feasibility and mid-term durability. Technical success was defined as successful stent graft deployment without conversion to open repair. Results: The cohort included one elective case in which a dedicated aorto-uni-iliac device was deemed unsuitable, three cases converted intraoperatively from bifurcated to aorto-uni-iliac configuration, and one case in which the dedicated device was unavailable. The aorto-uni-iliac configuration was achieved through off-label use of aortic extenders or an upside-down contralateral leg. All cases were technically successful. Three cases were emergency procedures. All cases required femoro-femoral crossover bypass. Slight type III endoleaks were detected in two cases on completion aortography but had resolved on postoperative computed tomography on days 11 and 16, respectively. No type III endoleaks were observed in any case during follow-up. No aneurysm-related deaths occurred. Over a median follow-up of 35 months (range: 1-62; excluding one same-day death), no sac enlargement was observed, suggesting acceptable durability. Median overall survival was 1,100 days (range: 0-1,966). Conclusions: Aorto-uni-iliac endovascular aortic repair using the Gore Excluder for abdominal aortic aneurysm is feasible when dedicated aorto-uni-iliac devices are unavailable or unsuitable, particularly in emergencies.

This report details a rare case of intraperitoneal bleeding from a failed puncture site during percutaneous trans-splenic portal vein access. A man in his 60s, who had undergone surgery for gallbladder cancer, presented with recurrent melena. Sclerotherapy for hepatopetal ectopic varices in the elevated jejunum loop was attempted using a percutaneous trans-splenic approach due to extrahepatic portal vein obstruction, which led to intraperitoneal bleeding. Despite initial splenic artery embolization, persistent bleeding required embolization of an intra-splenic vein branch. Although percutaneous trans-splenic portal vein access is generally safe, complications such as intraperitoneal bleeding can occur. Previous studies have highlighted the need for splenic artery embolization. However, this case emphasizes the importance of recognizing splenic venous bleeding as a potential complication and underscores the need for comprehensive management strategies.