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

Pelvic fractures are severe trauma that can cause hemorrhagic shock. The mortality rate is high when patients fall into shock. Therefore, prompt diagnosis and treatment are necessary. Hemostasis for hemorrhage associated with pelvic fractures is achieved through the mechanical stabilization of the fracture site, preperitoneal pelvic packing, and transcatheter arterial embolization. These techniques are frequently employed in hemodynamically unstable patients presenting with pelvic fractures. Among them, transcatheter arterial embolization is often considered the first-line choice: it is a particularly effective hemostatic method for arterial hemorrhage caused by pelvic fracture. An embolization technique and embolic agents should be considered comprehensively while considering the patient's hemodynamics, angiographic findings, and the urgency of the situation. This article describes the indications, techniques, results, and complications of transcatheter arterial embolization for pelvic fractures.

Left-sided portal hypertension (LSPH), an uncommon manifestation of portal hypertension, is characterized by conditions such as isolated gastric varices and splenomegaly, which result from impeded splenic venous drainage in the presence of pancreatic disease. We employed a percutaneous transhepatic technique to achieve regression of isolated gastric varices by implanting a covered stent within a blocked splenic vein and by embolizing the posterior gastric vein and varices using N-butyl-2-cyanoacrylate. We report the successful treatment of stenting for LSPH by the covered stent placement.

Magnetic resonance imaging (MRI) is one of the guiding modalities used for percutaneous needle insertion during interventional procedures. MRI guidance has several advantages, including multiplanar imaging capability, superior soft tissue contrast resolution, and the absence of ionizing radiation. When performing MRI-guided procedures, it is important to understand the suitable MRI systems, instruments, and imaging sequences for intervention. Furthermore, needle artifact characteristics must be fully understood to ensure safe and accurate needle insertion. In this article, we present the fundamental knowledge as regards the use of MRI guidance for percutaneous needle insertion and review its usefulness in representative interventional procedures, such as biopsy and tumor ablation.

Splenic injury is one of the most common abdominal parenchymal organ injuries. Since the spleen is a parenchymal organ with abundant blood flow, its injury can easily result in hemorrhagic shock. Therefore, prompt and appropriate management for hemostasis is critical. Management of splenic injury is determined by the hemodynamic status and the grade of injury. Splenectomy is the primary choice in cases with unstable hemodynamics, but splenic repair or non-operative management, including conservative treatment or transcatheter arterial embolization (TAE), may be chosen to preserve the spleen if time permits. Non-operative management has advantages over operative management in terms of complications and medical economics. TAE also plays a significant role in non-operative management by contributing to the improvement of patient outcomes.

Purpose: Image-guided percutaneous drainage for abscesses is known as a safe and effective treatment. The computed tomography-guided percutaneous drainage kit Drainaway (SB Kawasumi Co., Ltd.), developed on the basis of a modified trocar method, has made it possible to complete the procedure only under computed tomography guidance without radiographic fluoroscopy. This study investigated the feasibility and safety of Drainaway for abscess drainage.

Material and methods: In this retrospective observational study, 28 procedures in 27 patients (18 men and 9 women; age 67.0 ± 12.3 years) who underwent computed tomography-guided drainage using Drainaway between March and December 2021 at seven affiliated hospitals were analyzed. Patients with symptomatic, puncturable on computed tomography and refractory abscesses were included. Technical success (successful drainage with computed tomography alone), primary clinical success (successful drainage with Drainaway alone), secondary clinical success (avoidance of surgery), and complications were evaluated.

Results: The sites of the abscesses were the intraperitoneal, retroperitoneal, and thoracic cavities in 19, 5, and 2 patients, respectively, and subcutaneous tissue in 1 patient. The mean size of the abscesses was 7.1 ± 3.4 cm. The technical success rate was 96.4%; the ligament of the puncture route could not be penetrated in one case. The primary clinical success rate was 77.8%, whereas the secondary clinical success rate of catheter upsizing or replacement was 96.3%. Complications included one case of biliary pleurisy that required drainage.

Conclusions: Drainaway is a useful device that allows abscess drainage using only computed tomography guidance without radiographic fluoroscopy.

We present a case of gastric varices successfully treated with modified plug-assisted retrograde transvenous obliteration. A 45-year-old male patient had isolated fundal gastric varices caused by alcoholic cirrhosis. Contrast-enhanced computed tomography showed that the gastric varices were drained mainly via the gastro-renal shunt. The gastric varices were treated via plug-assisted retrograde transvenous obliteration using an IMPEDE vascular plug with a modified coil-assisted retrograde transvenous obliteration-II procedure. There were no complications during the procedure, and an endoscopic examination 3 months after the procedure revealed that the gastric varices had disappeared. To our knowledge, this is the first report on the application of plug-assisted retrograde transvenous obliteration-II using a newly designed IMPEDE vascular plug to avoid migration of the sclerosant.

Arteriovenous malformations (AVMs) consist of abnormal communications between the arteries and veins. They can involve any part of the body and extremity and grow in proportion to age and in response to hormonal influence or trauma. When symptoms progress from Schöbinger clinical stage II to III, transcatheter and/or direct puncture embolization are less-invasive and repeatable options for symptom palliation. The goal of embolization is to obliterate the AV shunt, and the choice of lesion access and embolic agents is based on the individual anatomy and flow. Embolization can be technically challenging due to complex vascular anatomy and morbidity risks. Therefore, a multidisciplinary management is essential for the diagnosis and therapeutic intervention of AVMs.