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

Purpose: Portal vein thrombosis (PVT), is seen in about 25% of patients with cirrhosis. Chronic portal vein thrombosis can significantly alter anatomy, often leading to the diversion of splanchnic blood into expansive and compliant vascular channels. This process generates extensive collateral networks and large varices that function as portosystemic shunts. Portal cavernous transformation represents a critical vascular condition marked by the formation of a network of collateral veins that develops to bypass an obstructed portal vein [PV]. Given these physiological changes, performing liver transplantation is associated with higher morbidity and mortality rates. We present an early, single-center experience for portal vein reconstruction (PVR) and the creation of a transjugular intrahepatic portosystemic shunt (TIPS) to increase transplant candidacy in such patients. Material and Methods: Retrospectively, data was obtained from the Picture Archiving and Communication System (PACS) and Hospital Information System (HIS) from a single center between January 2016 to January 2024. In total, 15 patients with obliterative main portal vein thrombosis were selected. These patients underwent Percutaneous transhepatic portal vein recanalization with transjugular intrahepatic portosystemic shunt to increase their transplant eligibility after a collaborative imaging examination by transplant surgery and interventional radiology team. Up until liver transplant LT, patients were monitored in the hepatology/transplant clinic, and thereafter in the posttransplant clinic. To confirm portal vein PV patency, serial ultrasound/Dynamic computed tomography/magnetic resonance imaging was done. Results: Portal vein recanalization with transjugular intrahepatic portosystemic shunt was performed in 15 patients. Technical success, defined as the maintenance of patency in both the portal vein and the transjugular intrahepatic portosystemic shunt at the conclusion of the procedure, was achieved in all 15 cases (100%). Conclusions: Patients with portal vein thrombosis may significantly benefit from portal vein recanalization with transjugular intrahepatic portosystemic shunt, enhancing transplantation candidacy and facilitating physiologic end-to-end anastomoses.

Purpose: To evaluate the efficacy and safety of the GORE^Ⓡ VIABAHN^Ⓡ Endoprosthesis (stent graft) for traumatic or iatrogenic vessel injury. Material and Methods: This prospective, multicenter, cohort study for post-marketing clinical surveillance was conducted in Japan. Efficacy and safety endpoints included successful device implantation, primary and secondary hemostasis of injury, 1-month and 1-year survival rate, and at 1-, 6-, 12-months post-procedure, primary and secondary patency rates, antiplatelet drug administration, and serious adverse events. Results: In 37 patients (mean age 73.3±12.5 years; 22 males; 59.5%), 38 vessel injuries were evaluated. Primary treated arteries were visceral, subclavian, and iliac arteries; 86.8% (33/38) were iatrogenic, and 13.2% (5/38) were traumatic vessel injury. Iatrogenic injury included pseudoaneurysm (63.6%), perforation (24.4%), rupture (15.2%), dissection (12.1%), or fistula (3.0%). Technical success in 36 patients (36/37; 97.3%) with 37 vessels (37/38; 97.4%), and primary and secondary hemostasis in all patients were achieved. Primary patency at 1-, 6-, and 12-months was 89.1%, 84.8%, and 80.6%, and secondary patency was 91.5%, 87.3%, and 82.4%, respectively. The Kaplan-Meier survival estimate was 94.4% through 1 month and 75.9% through 1 year. No device-related deaths occurred. Through 12 months, of the 19 serious adverse events (13 patients), three serious adverse events were judged by the investigator to be device-related (vascular stent graft stenosis) or procedure-related (device occlusion and cerebellar infarction). Conclusions: The use of the VIABAHN stent graft for vessel injury was safe and effective in this study. Successful hemostasis was achieved through 1 month. Through 1 year, no device-related deaths were reported.

This study reports a case of a J-shaped guidewire entrapped in a Chiari network during central venous port insertion. A female patient in her 50s with breast cancer was referred for a single-lumen port placement. The subclavian vein was accessed using an 18 G needle under ultrasound guidance, and a 0.035-inch J-shaped guidewire was passed to the superior vena cava under fluoroscopy. Resistance was encountered in the right atrium when advancing to the inferior vena cava, and the J-shaped guidewire was difficult to retract. The 4F catheter on the J-shaped guidewire was towed, and the J-shaped guidewire was removed despite strong resistance. The removed catheter was significantly deformed, and the J-shaped guidewire tip was entangled in a white, hard tissue, likely a Chiari network. The patient was asymptomatic intra- and postoperatively.

Chronic mesenteric ischemia typically presents with postprandial abdominal pain and weight loss due to atherosclerotic stenosis of mesenteric arteries. Endovascular treatment has become the first-line management, demonstrating lower early mortality and fewer complications compared to open surgery. Recent evidence shows that covered stents provide superior long-term outcomes, with better primary patency and freedom from reintervention than bare-metal stents. While patient selection remains crucial, with endovascular treatment being preferred for older, higher-risk patients and shorter lesions, it offers shorter hospital stays and comparable survival rates to open surgery for most patients. This review provides a comprehensive overview of current endovascular management strategies for chronic mesenteric ischemia, including patient selection, technical considerations, and outcomes.

Purpose: To determine how the anatomical morphology of the left subclavian artery and aortic arch affects the technical difficulty of navigating the aortic arch during left transradial access for visceral vascular interventions.

Material and methods: We retrospectively evaluated 98 patients who underwent visceral vascular interventions using left transradial access from January 2022 to December 2022. Cannulation of the descending aorta was considered difficult when the time required to manipulate the catheter in the aortic arch exceeded 30 seconds. The morphologies of the left subclavian artery and aortic arch were evaluated by measuring [1] the angle between the left subclavian artery to the apex of the aortic arch, [2] the angle of incidence of the left subclavian artery in the horizontal direction, and [3] the distance from the left edge of the left subclavian artery origin to the apex of the aortic arch using computed tomography images. The values of [1], [2], and [3] were evaluated using the Mann-Whitney U test.

Results: The median and mean catheterization times were 26 seconds (range, 2-1,312) and 112.4 ± 226.0 seconds, respectively. For difficult (n = 44) and not-difficult (n = 54) cases, the mean values of [1], [2], and [3] were 111.8° vs. 140.8° (p < 0.001), 67.3° vs. 76.9° (p < 0.001), and 27.5 mm vs. 24.7 mm (p = 0.001), respectively.

Conclusions: Technical difficulty in passing the aortic arch during left transradial access is more likely in patients with steep angles of the left subclavian artery or steep angles between the left subclavian artery and the apex of the aortic arch.

Purpose: A newly developed device, the Partially Automated Needle Direction Assistant, was designed to assist with computed tomography-guided oblique needle puncture. This device allows operators to accurately and in real-time determine the puncture angle based on the target lesion and needle entry point. The purpose of this report is to introduce the concept of Partially Automated Needle Direction Assistant and present results from an initial phantom study.

Material and methods: Partially Automated Needle Direction Assistant integrates a 9-axis internal measurement unit for angle detection, transmitting real-time orientation data to a tablet application via Wi-Fi. Operators align the needle direction with a displayed guideline. A phantom study was conducted with two operators of differing interventional radiology experience levels (operator A: 1 year; operator B: 4 years) performing needle punctures into embedded targets. Success rates were evaluated based on a scoring system reflecting needle placement accuracy.

Results: Both operators successfully punctured all six sites, achieving a 100% success rate. Center hits were not influenced by target size, puncture direction, or operator experience level. Operator A tended to achieve higher scores than operator B (mean scores: 1.50 vs. 1.17; p = 0.073).

Conclusions: Partially Automated Needle Direction Assistant demonstrated high accuracy and usability in guiding oblique needle punctures, regardless of operator experience. This device has the potential to enhance safety, reduce radiation exposure, and streamline computed tomography-guided interventions.

Endoscopic ultrasonography-guided biliary drainage has been reported as an alternative technique when transpapillary endoscopic biliary drainage fails. This case study describes a case of pseudoaneurysm, one of the complications unique to endoscopic ultrasonography-guided biliary drainage. An 87-year-old woman who underwent endoscopic ultrasonography-guided hepaticojejunostomy with a partially covered metallic stent developed hematochezia. Contrast-enhanced computed tomography revealed a pseudoaneurysm of the left hepatic artery adjacent to the stent. During coil embolization, angiography revealed bleeding, passing through the covered portion of the stent into the jejunum, and coil embolization was successfully performed. In cases after bile duct stent placement, where a tamponade effect can be expected, hepatic artery pseudoaneurysm may occur as a complication of puncture, and embolization may be required.

Vascular access dysfunction remains a significant challenge in hemodialysis patients, primarily caused by stenosis and occlusion in arteriovenous fistulas and grafts. Recent advancements in percutaneous transluminal angioplasty have introduced innovative tools such as drug-coated balloons and stent grafts. Drug-coated balloons enhance patency by reducing neointimal hyperplasia through localized drug delivery, with superior outcomes demonstrated in randomized controlled trials. Stent grafts provide structural support and mitigates restenosis at venous anastomoses but faces challenges in maintaining long-term patency. Cutting balloons, a well-established device, offer a unique mechanism of controlled fibroelastic disruption, making them effective for resistant stenoses. This review evaluates the clinical impact of these devices, focusing on evidence from Japan, and emphasizes the importance of selecting the appropriate device based on individual lesion characteristics.

Disruption of the central venous port catheter was identified on the chest radiograph of a 36-year-old woman who had undergone chemotherapy following resection of her colon cancer. Computed tomography revealed that the catheter was impacted in the peripheral pulmonary artery. Instead of using a snare wire, a balloon catheter was inserted into the lumen of the disrupted catheter due to its tight lodging in the pulmonary artery. The disrupted catheter was successfully removed without complications. This technique may prove useful when using a snare wire is deemed challenging, and a guidewire can be inserted into the catheter lumen.

Thoracic duct embolization has emerged as an alternative treatment for refractory chylothorax, in addition to thoracic duct ligation. Thoracic duct embolization is typically performed via direct puncture of the cisterna chyli and cannulation of the thoracic duct, or via a retrograde approach to the thoracic duct through the venous angle. The former requires a long puncture through abdominal organs; the latter has anatomical limitations depending on the case. The reported success rates of both approaches are insufficient to provide a complete solution. We report a case of refractory chylothorax successfully treated with thoracic duct embolization using a catheter inserted through a chest tube to cannulate the leaking stump of the thoracic duct. This technique offers a less invasive treatment option that avoids additional punctures or surgical intervention.