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

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.

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.