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

Purpose: Standard methods for percutaneous transhepatic portal vein embolization have not yet been established. This study aimed to elucidate the effectiveness of balloon occlusion in percutaneous transhepatic portal vein embolization using gelatin sponges on the hypertrophy ratio of the future liver remnant volume.

Material and methods: This retrospective study included 93 patients who underwent percutaneous transhepatic portal vein embolization for right hepatectomy between January 2018 and September 2022. Based on the embolization procedure, patients were divided into a balloon group (n = 13) and a non-balloon group (n = 80). The clinical factors and future liver remnant volume hypertrophy ratios were compared. Moreover, significant factors associated with the future liver remnant volume hypertrophy ratio between the groups were analyzed.

Results: The future liver remnant volume hypertrophy ratio was significantly higher in the balloon group than in the non-balloon group (1.44 [interquartile range, 1.37-1.89] vs. 1.29 [1.15-1.46], p = 0.011). The initial future liver remnant volume (289 [interquartile range, 259-454] vs. 400 [324-479] mL, p = 0.036) and number of gelatin sponge sheets (5 [interquartile range, 5-6] vs. 4 [3-5], p = 0.008) significantly differed. However, recanalization and severe complications were not different between groups. According to the multivariate linear regression analysis, diabetes mellitus (coefficient, -0.202, p = 0.009), initial future liver remnant volume (coefficient, -0.001, p < 0.001), and balloon occlusion (coefficient, 0.228, p = 0.007) were independent factors affecting the future liver remnant volume hypertrophy ratio.

Conclusions: Balloon occlusion may be effective in future liver remnant volume hypertrophy in percutaneous transhepatic portal vein embolization using gelatin sponges.

Purpose: We retrospectively analyzed the effect of coil type on the number of coils used and the procedure time in pre-Fontan coil embolization of collateral arteries.

Material and methods: Twelve patients with congenital heart disease underwent coil embolization before Fontan surgery between 2010 and 2021. They were divided into 2 groups. Group A comprised 6 patients who underwent coil embolization before the introduction of longer microcoils (≥30 cm) and group B comprised 6 patients who underwent embolization after the introduction of the microcoils. The primary endpoints (number of coils used, embolized area per patient and the internal thoracic artery, and procedure time) were compared between the 2 groups.

Results: The number of coils used per patient and internal thoracic artery (groups A vs. B: 36.5 vs. 18; p = 0.036, 11.7 vs 7.4; p = 0.047) and the procedure time (247 vs 180 minutes; p = 0.002) were significantly smaller in group B than in group A. The embolized area per internal thoracic artery was significantly larger in group B than in group A (45 vs. 93.5; p < 0.001). All patients underwent Fontan surgery at a mean of 24 days after embolization. Fontan circulation was established in nine of 12 patients. There were no major complications in either group.

Conclusions: In pre-Fontan coil embolization, a combination of longer microcoils (≥30 cm) may help reduce the number of coils used and the procedure time, which may decrease the health care cost and radiation exposure.

Lower extremity artery disease affects more than 230 million people worldwide, leading to significant cardiovascular and limb-related complications. Recent advancements in endovascular treatment, driven by technological innovations and increasing patient prevalence due to aging populations and lifestyle diseases, has contributed to a growing demand for endovascular treatment. In Japan, the number of endovascular treatment procedures has increased specifically among cardiologists, whereas the involvement of interventional radiology physicians remains limited. This review explores the latest trends and clinical outcomes of endovascular treatment, and the importance of multidisciplinary collaboration, including the role of interventional radiology physicians. The findings encourage greater involvement of interventional radiology physicians in endovascular treatment.

An 89-year-old woman presented with altered mental status. Computed tomography revealed multiple shunts between the portal (segment 3) and hepatic veins (left and middle hepatic veins); detailed vascular anatomy of the shunts could not be determined owing to its complexity. Blood tests revealed an elevated ammonia level. The patient was diagnosed with hepatic encephalopathy secondary to an intrahepatic portosystemic venous shunt. Transcatheter embolization was performed after unsuccessful conservative treatment. The peripheral left and middle hepatic veins downstream of the shunt vessels were embolized through an internal jugular vein approach using Amplatzer vascular plugs and coils. Computed tomography conducted 1 week later indicated occlusion of the shunts. The patient's ammonia levels were normalized. Thus, transcatheter embolization can be useful for treating complex intrahepatic portosystemic venous shunts causing hepatic encephalopathy.

Purpose: To investigate the risk factors for local maxillary sinus squamous cell carcinoma recurrence/residual tumor after superselective intra-arterial cisplatin infusion and concomitant radiotherapy.

Material and methods: The protocol of superselective intra-arterial cisplatin infusion and concomitant radiotherapy was as follows: cisplatin was administered once per week for 7 weeks, and the dose of every procedure was 100 mg/m². Radiation was administered during the same period using intensity-modulated radiation therapy, with a total dose of 70 Gy (2 Gy/35 fractions). The risk factors for local recurrence/residual tumor were retrospectively analyzed using the Cox hazard model in 31 advanced primary maxillary sinus squamous cell carcinoma cases treated with superselective intra-arterial cisplatin infusion and concomitant radiotherapy from October 2016 to 2022. The analyzed risk factors were age, sex, T- and N-factors, invasion of the pterygoid muscle, tumor heterogeneity on imaging modality, tumor signal intensity on diffusion-weighted imaging (b = 1000), tumor-brain stem signal ratio on diffusion-weighted imaging (b = 1000), therapeutic response after the fourth infusion, and complete superselective intra-arterial cisplatin infusion and concomitant radiotherapy or not. We also compared overall survival between the recurrence/residual tumor and non-recurrence groups.

Results: This study included 31 patients. Non-complete superselective intra-arterial cisplatin infusion and concomitant radiotherapy was the only risk factor that showed a statistically significant difference among all the analyzed risk factors. Overall survival was favorable in the non-recurrence/residual tumor group; however, there was no statistical difference compared to the recurrence/residual tumor group.

Conclusions: Complete superselective intra-arterial cisplatin infusion and concomitant radiotherapy was the only factor that prevented local recurrence/residual tumor. Therefore, all health careers involved in superselective intra-arterial cisplatin infusion and concomitant radiotherapy should avoid interrupting whenever possible.

A 74-year-old man who had received Bacillus Calmette-Guérin therapy for bladder cancer developed vasovagal syncope. Contrast-enhanced computed tomography showed multiple pseudoaneurysms in the left internal carotid artery, aorta, and right common femoral artery, which were considered to be infected aneurysms. Parent artery occlusion was planned for the left internal carotid artery, but the balloon occlusion test was not possible because of the patient's restlessness; therefore, the patient was treated with a Viabahn stent graft. Approximately 1 month later, another ruptured pseudoaneurysm occurred in the right internal carotid artery, which was also treated with a Viabahn stent graft. The patient did not experience rebleeding or complications such as cerebral infarction. Viabahn may be an effective alternative for the management of carotid artery-infected aneurysms.

This case report describes a 56-year-old woman with autosomal dominant polycystic kidney disease and chronic renal failure who underwent transcatheter arterial embolization with N-butyl-2-cyanoacrylate-Lipiodol before renal transplantation. Both kidneys were significantly enlarged, necessitating transcatheter arterial embolization to reduce renal volume and create space for transplantation. The right kidney volume decreased from 2520 to 1150 mL within 9 months after transcatheter arterial embolization, enabling successful transplantation. Long-term (37 months) follow-up demonstrated continued shrinkage of the transcatheter arterial embolization-treated right kidney and a spontaneous reduction in the non-transcatheter arterial embolization-treated left kidney. The reduction in renal volume achieved with transcatheter arterial embolization exceeded that reported for conventional methods using metal coils or ethanol. This case highlights the potential of as an effective embolizing agent for patients with autosomal dominant polycystic kidney undergoing renal transplantation.

Purpose: N-butyl cyanoacrylate is a liquid embolic material used to treat bleeding. Rebleeding may occur after N-butyl cyanoacrylate embolization due to vasospasm and dilation of the embolized artery. However, the impact of vasospasm on N-butyl cyanoacrylate embolization has not been fully investigated. Therefore, we investigated the impact of vasospasm on the effects of N-butyl cyanoacrylate embolization in swine arteries.

Material and methods: Using a swine bleeding model, 24 arteries (hepatic/splenic/both renal/cranial mesenteric) in 5 swine were divided into vasoactive and control groups. The recanalization rates after embolization with 20% N-butyl cyanoacrylate and the volume of N-butyl cyanoacrylate used for embolization were compared between the 2 groups. Arteries in the vasoactive group were constricted by constant venous infusion of vasopressin and an arterial injection of noradrenaline just before embolization and then dilated by arterial injection of papaverine and lidocaine immediately after embolization. Angiography was performed to evaluate recanalization of the embolized arteries immediately and at 5, 15, 30, 45, and 60 minutes after embolization. Recanalization was defined as complete recanalization within 60 minutes or partial recanalization at 60 minutes.

Results: Angiography revealed recanalization in a significantly greater proportion of arteries in the vasospasm group (11/12 arteries [91.7%]) than in the control group (2/12 arteries [16.7%]) (p = 0.0006). The median volume of N-butyl cyanoacrylate used during embolization was significantly lower in the vasoactive group (0.32 mL) than in the control group (0.78 mL) (p = 0.0037).

Conclusions: Vasospasm during N-butyl cyanoacrylate embolization increased the recanalization rate of the embolized arteries and reduced the embolization effect in swine.

A 75-year-old man with a history of open surgical repair for a thoracoabdominal aortic aneurysm presented with an aortic pseudoaneurysm at the anastomosis and a celiac artery aneurysm. During endovascular treatment, multiple celiac artery branches were embolized, and an aortic stent graft was placed to cover the aortic anastomosis and celiac artery origin. Four days post-treatment, a computed tomography scan revealed poor enhancement and fluid collection in the pancreatic body and tail, indicating acute ischemic pancreatitis with pancreatic necrosis. Computed tomography 22 days after treatment indicated enlargement of the fluid collection, leading to endoscopic ultrasound-guided drainage of the collection. Despite the low risk of ischemic complications, recognizing the risk of ischemic pancreatitis and splenic infarction when multiple celiac artery branches are embolized to treat celiac artery aneurysms is crucial.

Preemptive side branch embolization may help prevent type II endoleak, reduce reintervention rates, and promote early aneurysm sac shrinkage after endovascular aneurysm repair. However, evidence of its effectiveness in preventing aneurysm rupture, reducing aneurysm-related mortality, ensuring safety, and maintaining cost-effectiveness is limited. The 2024 European Society for Vascular Surgery guidelines do not recommend routine preemptive embolization due to a lack of high-quality evidence. Concerns about radiation exposure and financial costs remain unresolved. Further research is needed to identify patients who would benefit most from preemptive embolization, as well as to evaluate its long-term impact on clinical outcomes, safety, and cost-effectiveness.