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

Arterial esophageal hemorrhage, a relatively rare condition, necessitates prompt therapeutic intervention. The esophageal arteries, originating directly from the aorta and being extremely narrow, are often difficult to identify through angiography alone. We report two cases of arterial esophageal hemorrhage related to esophageal cancer in which the esophageal arteries were identified by contrast-enhanced computed tomography prior to angiography, enabling successful transcatheter arterial embolization. Arterial esophageal hemorrhage requires rapid treatment intervention due to its complex blood supply. Preoperative evaluation with computed tomography appears to be effective.

Endoleak is a significant complication of endovascular aortic repair, associated with adverse long-term outcomes. This review discusses the classification, mechanisms, and imaging diagnosis of endoleaks. Five types of endoleaks are described, each with distinct characteristics and management approaches. Imaging modalities for endoleak detection include computed tomography, magnetic resonance imaging, ultrasonography, and angiography, each with unique advantages and limitations. Computed tomography remains the gold standard, but magnetic resonance imaging and contrast-enhanced ultrasound show promise in specific scenarios. The article details imaging findings for each endoleak type, emphasizing the importance of multimodality imaging for accurate diagnosis. While computed tomography is essential for early postoperative evaluation and reintervention planning, a tailored approach using various imaging techniques may optimize long-term surveillance. Future research should focus on establishing cost-effective, radiation-minimizing protocols for lifelong post-endovascular aortic repair monitoring.

Type II endoleak is the most common complication after endovascular abdominal aortic aneurysm repair. Type II endoleak with aneurysm sac growth is not benign for long-term outcomes of endovascular abdominal aortic aneurysm repair and should be treated to prevent secondary stent graft-related complications and aneurysm rupture. The current consensus is to consider treatments for persistent type II endoleak with significant aneurysm sac growth. For complete embolization of type II endoleak to obliterate the endoleak cavity with the elimination of all supplying arteries, it is necessary to select and combine the treatment options. Although the treatment techniques for type II endoleak have advanced, clinical outcomes remain unsatisfactory. To overcome this clinical discrepancy, the optimal patient-tailored treatment strategy is required in clinical practice, with an understanding of the current status and limitations of treatment for type II endoleak.

Purpose: This study aimed to evaluate type II endoleak incidence and its outcome in patients who underwent endovascular aneurysm repair using the EXCLUDER device for abdominal aortic aneurysm. Material and Methods: One hundred sixty-seven patients who underwent endovascular aneurysm repair for abdominal aortic aneurysm (96 with patent and 71 with occluded inferior mesenteric artery) between 2008 and 2017 were retrospectively evaluated. Type II endoleak incidence and aneurysm enlargement of >5 mm after endovascular aneurysm repair were evaluated. The predictive factors for late type II endoleak identified >6 months after endovascular aneurysm repair and aneurysm enlargement were assessed based on the preoperative patient and anatomical characteristics. Results: Late type II endoleak incidence was higher in the patent inferior mesenteric artery at 42.7% (41/96; 95% confidence interval, 33.3-52.7), compared with 22.5% (16/71; 95% confidence interval, 13.5-34.0) in the occluded inferior mesenteric artery group (p = 0.01). Freedom from aneurysm sac enlargement at 1, 3, and 5 years was 100%, 85.0%, and 68.1% in the patent inferior mesenteric artery and 98.9%, 86.7%, and 73.9% in the occluded inferior mesenteric artery group, respectively (p = 0.22). Freedom from aneurysm sac enlargement at 1, 3, 5 years was 100%, 76.9%, 43.5%, and 99.1%, 90.6% and 87.8% in the patients with and without late type II endoleak (p < 0.01). Patent inferior mesenteric artery (odds ratio, 3.43; 95% confidence interval, 1.43-8.21) and an increasing number of patent lumbar arteries (odds ratio, 2.14; 95% confidence interval, 1.48-3.08) were risk factors for late type II endoleak. Conclusions: Patent inferior mesenteric artery was a risk for late type II endoleak without contributing to aneurysm enlargement after endovascular aneurysm repair using the EXCLUDER. Late type II endoleak was associated with aneurysm enlargement. Patent inferior mesenteric artery and an increasing number of patent lumbar arteries were risk factors for late type II endoleak.

Purpose: To evaluate the ability of automated supply artery tracking software to detect feeding vessels for renal tumors using preoperative dynamic contrast-enhanced computed tomography. Material and Methods: For 10 sessions in 10 patients in which transarterial embolization was performed before percutaneous ablation therapy for a single renal cell carcinoma, data that had been obtained from dynamic contrast-enhanced computed tomography in the arterial phase were examined. Automated supply artery tracking software was retrospectively applied with arterial phase images of preoperative contrast-enhanced computed tomography, and the extracted feeding vessels were identified by two observers: a radiologist and a radiological technologist. Real supply arteries were determined by arteriography during transarterial embolization. Extracted feeding vessel and real supply arteries were compared. The concordance rate of extracted feeding vessel between observers was examined. Sensitivity and positive predictive value of automated supply artery tracking software and changes in sensitivity and positive predictive value under conversion of the distance recognized as extracted feeding vessel between the tumor and vessels from the preset distance (20 mm) to the cut-off value using receiver operating characteristic curve analysis were investigated. Results: Twenty real supply arteries were identified among 10 cases. Number of extracted feeding vessel was 32 and 34 by the observers. The concordance rate of extracted feeding vessel was 80% (8/10 cases). Sensitivity of automated supply artery tracking software was 70% (14/20) by both observers and positive predictive value was 43.8% (14/32) and 41.2% (14/34) by each observer. When the cut-off value (12.1 mm) replaced distance, positive predictive value was elevated from 43.8% to 73.7% and from 41.2% to 68.4%. Conclusions: Ability of automated supply artery tracking software based on transvenous contrast-enhanced computed tomography was acceptable for identifying feeding vessels of a renal tumor preoperatively.

Although transcatheter arterial embolization is the first choice treatment for renal arteriovenous malformation. Renal arteriovenous malformation with dilated venous sac can cause venous pulmonary thromboembolism after transcatheter arterial embolization. A woman in her 60s was diagnosed with a left renal arteriovenous malformation and an 8 cm venous sac with renal dysfunction after right renal arteriovenous malformation treatment. We performed a hybrid treatment of transcatheter arterial embolization and sequential vein ligation to reduce the risk of lethal thrombotic complications. After treatment, the left renal arteriovenous malformation disappeared without fatal complications, and the venous sac shrunk with the preservation of renal function as it was before the hybrid treatment. When performing embolization of renal arteriovenous malformation with a huge venous sac, hybrid treatment of arterial embolization and surgical vein ligation may be safe and useful for preventing fatal post-operative thrombotic complications.

Purpose: To retrospectively assess the clinical outcomes of repeated radiofrequency ablation for lung metastases of head and neck adenoid cystic carcinoma. Material and Methods: Consecutive 16 patients (mean age, 55.3 years) who were treated with radiofrequency ablation for 289 lung metastases were included. A 17-gauge electrode was used in all radiofrequency ablation procedures and placed under computed tomography fluoroscopic guidance. Evaluated were safety, technical success, local tumor control, and survival. Results: In total, 143 radiofrequency ablation sessions were performed for 289 lung metastases. One session of radiofrequency ablation was not completed due to pleural hemorrhage during the procedure, resulting in a technical success rate of 99.3% (142/143). Major complications (pneumothorax and hemorrhage) occurred in 40 sessions (27.9%, 40/143). During the mean follow-up period of 5.5 ± 3.6 years (range, 0.4-13.4 years), local tumor progression was observed in 16 tumors (5.5%, 16/289) and repeated radiofrequency ablation (93.8%, 15/16) or metastasectomy (6.2%, 1/16) was performed for all locally progressed lung metastases. The local tumor control rates were 97.1% (95% confidence interval, 95.1%-99.2%) and 89.5% (95% confidence interval, 84.0%-95.0%) at 1- and 5-year. Median survival time after initial lung radiofrequency ablation was 9.8 years and 1-, 3-, 5-, and 10-year overall survival rates were 100% (95% confidence interval, 100%), 91.7% (95% confidence interval, 76.0%-100%), 64.3% (95% confidence interval, 35.7%-92.9%), and 35.7% (95% confidence interval, 0%-70.8%), respectively. Conclusions: Repeated radiofrequency ablation for multiple lung metastases of adenoid cystic carcinoma was feasible and safe and may allow survival with good local control of lung metastases.

Endovascular treatment for patients with lower extremity artery disease is conducted worldwide due to its efficacy. Many studies have shown durability for patients with intermittent claudication, and various guidelines have shifted to the use of endovascular treatment. However, clinical outcomes in patients with chronic limb-threatening ischemia who undergo endovascular treatment have not been fully investigated. Generally, chronic limb-threatening ischemia cases have complex lesions such as small vessels, severe calcification, poor runoff vessels, chronic total occlusion, and long lesions, which result in poor outcomes. Thus, endovascular treatment for chronic limb-threatening ischemia cases remains challenging, despite the many technical and device advances. In 2019, the Global Vascular Guidelines were proposed for the treatment of patients with chronic limb-threatening ischemia. Here, we review previous guidelines and reports of patients with lower extremity artery disease who underwent endovascular treatment.

Postoperative chylous ascites is a rare condition that can be caused by abdominal and pelvic surgery. The mortality rate associated with untreated postoperative lymphorrhea is as high as 50%. Conservative management is the primary treatment, and most patients improve. However, some patients continue to exhibit high-volume chylous ascites and need invasive intervention. Many surgical series have shown that the outcomes of patients with chylous ascites were unfavorable. Therefore, the need for minimally invasive interventional radiology procedures, such as intranodal lymphangiography, thoracic duct, lymphatic pseudoaneurysm, lymph node, hepatic lymphatic embolization, and peritoneovenous shunting, is increasing. This review describes the anatomy, physics, and diagnosis related to interventional radiology for postoperative chylous ascites as well as interventional radiology treatment options and strategies for this condition referring to recent literature.

A 60-year-old male presented with jaundice. He had a history of extended left hepatectomy, cholecystectomy, hepaticojejunostomy for moderately to poorly differentiated hepatocellular carcinoma, and transverse colectomy for transverse colon cancer. Computed tomography showed hepatocellular carcinoma recurrence in the liver, extending from the hepaticojejunostomy site to the elevated jejunum, resulting in obstructive jaundice. Internal biliary drainage using a percutaneous transhepatic approach was planned. However, the guidewire could not pass through the obstruction caused by the tumor at the hepaticojejunostomy site. After performing hepatic arterial infusion chemotherapy, to reduce the tumor volume, transcatheter arterial chemoembolization was performed for hepatocellular carcinoma recurrence. After transcatheter arterial chemoembolization, the catheter was successfully advanced beyond the tumor at the elevated jejunum owing to tumor shrinkage, thus completing internal biliary drainage.