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

Purpose: This study aimed to show balloon dilation of the puncture site as a technique to facilitate insertion of a large-bore sheath in patients undergoing percutaneous endovascular aneurysm repair who have previously undergone femoral cutdowns. Materials and Methods: Three patients with prior femoral cutdowns who required percutaneous insertion of a large-bore sheath were included. After ultrasound-guided puncture of the femoral artery and preparation with a Perclose ProGlide suture, attempts to insert a 12F sheath using a dilator were unsuccessful. Consequently, a 5-mm-diameter balloon catheter was used to dilate the puncture site. Results: In two patients, the balloon dilation allowed smooth sheath insertion without bleeding complications. Adequate hemostasis was achieved post-procedure. However, in the third patient, despite high-pressure balloon dilation, residual stenosis prevented sheath insertion. The stenosis was attributed to the puncture path crossing vascular sutures from the previous cutdown, leading to a decision to relocate the puncture site, which then allowed successful sheath insertion. Conclusion: Balloon dilation at the puncture site is a viable technique for overcoming challenges in sheath insertion during percutaneous endovascular aneurysm repair in patients with previous femoral cutdowns. In cases in which the puncture site cannot be dilated with the use of a balloon, alternative strategies, such as changing the puncture site, are necessary.

Intravascular large B-cell lymphoma is a rare, aggressive lymphoma characterized by intravascular growth. The liver is a common site of involvement. Although liver biopsy provides sufficient tissue for diagnosis and treatment planning, it carries a risk of severe hemorrhage. This report describes the case of a woman in her 50s with intravascular large B-cell lymphoma who developed liver hemorrhage that was uncontrollable by transarterial embolization after undergoing ultrasound-guided percutaneous liver biopsy, necessitating laparoscopic hemostasis. Pathological findings revealed markedly dilated liver sinusoids filled with tumor cells, suggesting direct hemorrhage from these vessels. This case highlights the potential for increased hemorrhage risk in intravascular large B-cell lymphoma and underscores the necessity for careful consideration of alternative biopsy techniques, such as the transjugular approach or percutaneous biopsy with tract embolization.

We report a case of Budd-Chiari syndrome successfully treated with endovascular recanalization of an inferior vena cava occlusion using a modified sharp recanalization technique. A 45-year-old man presented with hepatic dysfunction, and contrast-enhanced computed tomography revealed a 1.5 cm chronic inferior vena cava occlusion. Standard sharp recanalization using the conventional end of a guidewire failed to cross the lesion. Therefore, we reshaped the end of a 0.035-inch guidewire into a sharper form, enabling successful penetration without the use of specialized devices. This modified technique, adapted from peripheral artery interventions, may offer a safer and more cost-effective option for treating fibrotic venous occlusions. Stepwise balloon dilation was subsequently performed to minimize complications. This report highlights the potential utility of a reshaped guidewire end as a practical alternative when the conventional technique fails.

This review highlights the role of interventional radiology in the management of renal trauma, emphasizing its contributions to imaging-based diagnosis, injury classification, and treatment. It discusses the indications for and clinical outcomes of transcatheter arterial embolization, as well as the management of renal artery dissection and urinary extravasation. Transcatheter arterial embolization has demonstrated favorable outcomes, even in high-grade injuries, and repeat procedures have proven effective for managing rebleeding. Renal artery dissection may be treated with stent placement to preserve renal function. Although urinary extravasation often resolves spontaneously, persistent cases may require ureteral stenting or percutaneous drainage. Additional interventional radiology-based interventions, including embolization and cryoablation, have also been reported. As a minimally invasive, organ-preserving treatment modality, interventional radiology plays a vital role in supporting non-operative management strategies for renal trauma.

The need for interventional radiology in hemostatic strategies for postpartum hemorrhage has been growing as a reliable and hopeful treatment method because of its non-invasive characteristics, high success rate of hemostatic outcomes, and potential to preserve fertility. Moreover, with the global trend of increasing postpartum hemorrhage, interventional radiology is expected to play an important role. An accurate pre-procedural diagnosis of the underlying cause of bleeding, including tone, trauma, tissue, or thrombin, utilizing contrast-enhanced computed tomography and clinical information, is essential for planning the appropriate technical approach to interventional radiology. This study outlines the fundamental aspects of primary postpartum hemorrhage, compares the computed tomography imaging characteristics associated with various causes, and discusses the appropriate procedural choices of interventional radiology based on the identified etiology.

Uterine artery embolization is a treatment option for symptomatic uterine myomas. The Japanese Society of Interventional Radiology Guideline Committee developed guidelines for uterine artery embolization procedures for symptomatic uterine myomas using an evidence-based methodology. This report describes the rationale for developing these guidelines and provides answers to clinical questions concerning uterine artery embolization procedures based on existing evidence and expert consensus.

Purpose: To evaluate the sample weights obtained using a new semi-automatic biopsy needle and a new full-core biopsy needle, and to compare them with those obtained using a conventional semi-automatic needle under identical ex vivo conditions. Material and Methods: A total of three biopsy needles were compared: the semi-automatic biopsy needles TEMNO Elite™ (Merit Medical Systems, South Jordan, UT, USA) and STARCUT^Ⓡ (TSK Laboratory, Tochigi, Japan) and the full-core automatic biopsy needle CorVocet™ (Merit Medical Systems), with throw lengths of 15 mm, 20 mm, and 25 mm. Two materials were used for sampling: kamaboko (a type of Japanese fish cake) and chicken breast muscle. For each material, 20 specimens were collected using each needle type, resulting in 100 samples per material. All procedures were conducted under identical conditions. Results: The TEMNO Elite™ needle yielded the heaviest samples among all tested needles in both kamaboko (9.21 ± 0.95 mg) and chicken breast (5.92 ± 0.51 mg), significantly surpassing all others (p < 0.05). STARCUT^Ⓡ collected significantly more tissue than CorVocet™ (15 mm) in both materials (p < 0.05), while CorVocet™ (25 mm) collected more than STARCUT^Ⓡ in chicken breast (p < 0.05). No significant difference was observed between STARCUT^Ⓡ and CorVocet™ (20 mm) in both materials. For CorVocet™, sample weight increased with throw length in both materials. Conclusions: The TEMNO Elite™ needle collected the heaviest biopsy specimens among all tested needles in both model materials.

This case report presents a unique endovascular technique using an electrically detachable coil as a temporary anchor for the treatment of a saccular celiac artery aneurysm. A man in his 60s with a 28-mm saccular aneurysm in the main trunk of the celiac artery underwent coil embolization. The short distance between the aneurysm and the bifurcation of the common hepatic and splenic arteries posed a significant challenge in preserving the bifurcation. By employing a detachable coil as a temporary anchor, the procedure enabled precise coil placement and eliminated the need for stents or balloons. Five-year outpatient follow-up imaging confirmed bifurcation patency and no aneurysm recurrence. This temporary anchoring technique can provide a practical alternative for embolization without the need for additional stents or balloons.

Purpose: To evaluate the performance of automated tumor-feeder detection software in transarterial chemoembolization for hepatocellular carcinoma using angio-computed tomography. Material and Methods: This was a retrospective study of 107 hepatocellular carcinomas in 74 patients who underwent selective transarterial chemoembolization between June 2021 and December 2022. Identification of tumor-feeding arteries on computed tomography during hepatic angiography images acquired prior to chemoembolization with angio-computed tomography was evaluated in two independent methods: analysis by automated tumor-feeder detection software and interpretation by radiologists. The sensitivity and positive predictive value of both were calculated, and the sensitivity was compared with the McNemar test. Differences with p <0.05 were considered statistically significant. Results: Transarterial chemoembolization was applied to 107 hepatocellular carcinoma tumors fed by 114 arteries. No significant difference was observed in sensitivity between the software and the interpretation of radiologists (90.4% vs. 95.6%, p = 0.15). The positive predictive value for the software was 90.4%; that for the interpretation of radiologists was 86.8%. Conclusions: The accuracy of automated tumor-feeder detection software applied to angio-computed tomography was comparable to that of radiologists.

Prostatic artery embolization is a minimally invasive treatment for lower urinary tract symptoms caused by benign prostatic hyperplasia. We report our first case of prostatic artery embolization in a 74-year-old male with urinary retention requiring intermittent catheterization. Bilateral prostatic artery embolization using Embosphere microspheres was successful, with no major complications. By 2 months post-procedure, intermittent catheterization was no longer required, and at 6 months, symptoms and prostate volume showed marked improvement. A review of Asian studies confirmed prostatic artery embolization's safety and efficacy, with clinical success in 78%-100% of cases and technical success rates comparable to those in Western countries. Despite the smaller vessel sizes in Asians, outcomes were unaffected. Prostatic artery embolization appears to be an effective treatment for benign prostatic hyperplasia and requires further validation to support its broader use in Japan.